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Anxiety, depression and sleep in male patients undergoing coronary artery bypass surgery
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
Department of Neuroscience, Faculty of Medicine, Uppsala University, Sleep Disorders Unit, University Hospital, Uppsala, Sweden.
1999 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 13, no 2, 137-143 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to examine the prevalence of depression and anxiety following coronary artery bypass surgery (CABG) and to see how those patients with depression and anxiety differ in sleeping pattern. The individual reaction to sleep loss was tested as a predictor of certain emotional symptoms in the follow-up period. Thirty-eight males, between 45 and 68 years, were interviewed prior to, and 1 month after, surgery, and received a questionnaire at the 6-month follow-up. Eighty per cent scored moderate anxiety prior to surgery and six patients were depressed. An anxiety-prone individual reactivity persisted in the same patients in 38.9% (n = 14) following CABG, with significantly more sleep disturbances, firedness, energy deficits, immobility, and lower degree of quality of life (QoL). Sad/depressed mood or cognitive/behavioural fatigue symptoms as reactions to sleep loss were predictors of sleep problems and daytime sequelae, whereas a higher postoperative NYHA class was predicted by cognitive/behavioural fatigue and dysphoria reactions. Being less refreshed by sleep on final awakening prior to surgery related to 44.5% of the variance in QoL outcome 6 months following surgery. In conclusion, an anxiety-prone individual reactivity is significantly associated with sleep disturbances. Reactions to sleep loss prior to surgery are associated with emotional distress after surgery.

Place, publisher, year, edition, pages
Taylor and Francis Ltd , 1999. Vol. 13, no 2, 137-143 p.
Keyword [en]
Anxiety, · coronary artery bypass surgery, moad, personality, sleep
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-28414Local ID: 13551OAI: diva2:249220
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2010-03-23
In thesis
1. Sleep, psychological symptoms and quality of life in patients undergoing coronary artery bypass grafting
Open this publication in new window or tab >>Sleep, psychological symptoms and quality of life in patients undergoing coronary artery bypass grafting
1999 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In this thesis sleep, psychological symptoms and quality of life (Qol) in patients undergoing coronary artery bypass grafting (CABG) at the University Hospital in Linköping were evaluated. Interviews and 24-hour polysomnography were performed prior to surgery, immediately after surgery and again at one month, with a six-month-follow-up mailed questionnaire. Habitual sleep was evaluated using the Uppsala Sleep Inventory questionnaire and a diary the recorded mornings. The Spielberger State of Anxiety Scale and the Zung's Self-rating Depression Scale were used to measure anxiety and depression, respectively. Physical functional capacity was assessed according to the New York Heart Association's (NYHA) classes and Qol, with the Nottingham Health Profile instrument (NHP).

A retrospective evaluation of nurse's documentation about sleep was also performed. In addition, the quality and quantity of sleep were assessed before surgery and in the immediate postoperative period in a pilot study, with a one-month follow-up interview. The results indicated disturbed sleep, and changes in behaviour and mental state after surgery due to fragmented sleep, pain and anxiety.

Forty-four patients were examined prior to surgery. The results showed that almost two-fifths experienced too little sleep habitually and 50 % had a combination of at least two sleep problems. Poorer health, higher level of anxiety and increased difficulties maintaining sleep (DMS) were consistent with significantly longer sleep latency, increased fragmented sleep, and reduced stages 3 and 4 and RIM sleep measured by polysomnography. The level of Qol on the NBP was significantly associated with objectively measured sleep.

In the immediate period following CABG there is a changed distribution of sleep, with a reduction of nocturnal sleep duration and an increase in daytime sleep, which had almost returned to preoperative values one month after surgery. Qol was significantly improved six months after surgery compared to before surgery.

It was noted that patients with a more anxiety prone reactivity during six months following CABG had significantly more sleep disturbances, reduced energy and functional physical capacity, and lower quality of life, compared to those without such reactivity. Significantly more sleep disturbances, reduced energy and lower quality of life were more prominent among those with sadness/depression or cognitive/behavioural fatigue as reactions to sleep loss. A higher degree of cognitive/behavioural fatigue and dysphoria reactions were associated with a higher NYHA class.

In conclusion, patients with coronary artery disease have poor quantity and quality of sleep. Increased psychological symptoms in patients with CAD prior to surgery were associated with greater symptoms six months after surgery. Physical functional capacity and quality of life were significantly improved six months after surgery.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 1999. 73 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 584
Sleep, polysomnography, coronary disease, surgery, anxiety, psychophysiological disorders, personality
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-28419 (URN)13556 (Local ID)91-7219-324-7 (ISBN)13556 (Archive number)13556 (OAI)
Public defence
1999-02-19, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
1999Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-01-24Bibliographically approved

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