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Sleep, psychological symptoms and quality of life in patients undergoing coronary artery bypass grafting
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
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.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 584
Keyword [en]
Sleep, polysomnography, coronary disease, surgery, anxiety, psychophysiological disorders, personality
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-28419Local ID: 13556ISBN: 91-7219-324-7 (print)OAI: oai:DiVA.org:liu-28419DiVA: diva2:249227
Public defence
1999-02-19, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Note
1999Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-01-24Bibliographically approved
List of papers
1. Nurses´ notes on sleep pattern in patients undergoing artery bypass surgery: a retrospective valuation of patient records
Open this publication in new window or tab >>Nurses´ notes on sleep pattern in patients undergoing artery bypass surgery: a retrospective valuation of patient records
1994 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 20, 331-336 p.Article in journal (Refereed) Published
Abstract [en]

In this study, patient records from 80 male patients, aged 43-76, undergoing first-time coronary artery bypass surgery were evaluated with regard to nurses' documentation on sleep during the first four postoperative days. This documentation was classified into descriptions of quality and quantity of sleep. Notations on sleep were found in 69-86% of patient records each night, and was most common the second night. Descriptions of both quality and quantity of sleep occurred in only 12 out of 320 patient-nights. Notes regarding duration of sleep were found for 146 patient-nights (45.6%), of which 103 (32.2%) contained sleep disturbances. Information on quality of sleep was given for 116 patient-nights (36.3%), with only 38 patient-nights (11.9%) of sleep disturbances. For 72 patient-nights, documentation of the patients' sleep was lacking. Frequent awakening was the most common sleep disturbances noted during all but the first night, when continuous awakening dominated. We conclude that the nurses' documentation regarding sleep and sleep disturbances varied over a wide range, with a mixture of quantitative and qualitative information, and that more structured descriptions are needed.

Place, publisher, year, edition, pages
Elesvier, 1994
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28411 (URN)13547 (Local ID)13547 (Archive number)13547 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
2. Measurement of sleep and quality of life before and after coronary artery bypass grafting: A pilot study
Open this publication in new window or tab >>Measurement of sleep and quality of life before and after coronary artery bypass grafting: A pilot study
1997 (English)In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 3, no 4, 239-246 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to: (i) test different instruments that focused on sleep, quality of life and personal adjustment in order to evaluate the usefulness of these instruments in a larger study; and (ii) to describe self perceptions of sleep and life situation by patients who had undergone coronary artery bypass grafting (CABG). A one-group pre-test repeated post-test design was used. Six men aged between 51 and 70 years were interviewed, and 24 h polysomnographic recordings were performed before and after the operation. The interviews indicated disturbed sleep and changes in behaviour and mental state immediately postoperatively. Postoperatively the polysomnographic recordings revealed a significant decrease in mean duration of sleep, mean percentage of stage 3-4 sleep and mean rapid eye movement (REM) sleep. One month after surgery the quality of life was improved, while moderate anxiety and sensation of incisional pain persisted. The measurements used in this pilot study provide valuable information into the understanding of altered sleep, quality of life and personal adjustment following CABG.

Place, publisher, year, edition, pages
Wiley, 1997
Keyword
Coronary artery bypass surgery, nursing, psychophysiological disorders, quality of life, sleep pattern disturbances
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28412 (URN)10.1111/j.1440-172X.1997.00051 (DOI)13549 (Local ID)13549 (Archive number)13549 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
3. Sleep in patients with coronary artery disease: a polysomnographic study
Open this publication in new window or tab >>Sleep in patients with coronary artery disease: a polysomnographic study
(English)Manuscript (preprint) (Other academic)
Abstract [en]

OBJECTIVES: To describe reported sleep and po1ysomnographically measured sleep andinvestigate its re1ationship.

DESIGN: A descriptive compa1'ative study.

SETTlNG: On the waiting-list for heart surgery.

PATIENTS: A consecutive sample, 44 men, aged 45-70.

OUTCOME MEASURES: Sleep and CAD.

RESULTS: Twenty-two patients (50 %) had combined complaints of sleep difficulties.Po1ysomnographically recorded nocturnai sleep duration was 368 ± 72 minutes anddaytime sleep 35 minutes. Subjective1y and objective1y measured sleep were similar. Ahighe1' anxiety 1eve1 was associated with more stage 1 sleep (r=0.39, p<O.Ol) andfrägmented sleep (r=0.54, p=O.OOOl). mereased difficulties maintaining sleep we1'eassociated significantly with less stages 3-4 sleep (r=-0.35, p<0.02), less REM sleep (1'=0.33,p<0.03) and increased arousa1s/movements (r=0.35, p=0.02). The prevalence ofdaytime napping was high. A higher degree of being physically tired was associated withless stages 3-4 sleep (p<0.05).

CONCLUSION: Po1ysomnographically recorded sleep pattems we1'e consistent withreported sleep. Sleep disturbances are common in patients with verified obstructive CAD.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54548 (URN)
Available from: 2010-03-23 Created: 2010-03-23 Last updated: 2010-03-23
4. Sleep and quality of life assessment in patients undergoing coronary artery bypass grafting
Open this publication in new window or tab >>Sleep and quality of life assessment in patients undergoing coronary artery bypass grafting
1999 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 29, no 5, 1213-1220 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To examine sleep before and after coronary artery bypass grafting (CABG) as well as measuring of quality of life (QoL), and to see if changes in subjectively rated sleep can be shown objectively by polysomnographic recordings. Sample: A consecutive sample of 38 male patients, aged 45-68, underwent CABG, Twenty-two patients were graded in New York Heart Association (NYHA) classes III or IV, and 16 in class I-II before surgery.

METHODS: 24-hour polysomnographic recordings, using the Oxford Medilog 9000 recorder, were performed 2 days prior to surgery, on the first 2 post-operative days and 1 month after surgery. The Nottingham Health Profile instrument (NHP) was used to measure QoL before and after surgery.

RESULTS: Following surgery there was a profound decrease in sleep at night, and an increase in daytime sleep. During the second post-operative recording period nocturnal sleep duration was reduced to 253.6 +/- 94.1 minutes, with suppressed stages 3 and 4 sleep and lack, or slight recovery, of REM sleep. Even though there were evident changes in both the distribution and nature of sleep at night, daytime sleep increased and the total duration of sleep during the 24-hour period was not significantly changed. The total sleep time was 421.1 +/- 76.8 minutes before surgery, 483.2 +/- 201.2 in the first period, 433.2 +/-201.4 minutes in the second 24-hour period post-operatively and 443.2 +/- 44.0 minutes at the 1-month follow-up. The NHP instrument demonstrated that 6 months after surgery the quality of life was significantly improved. Polysomnographically measured slow wave sleep was compared with the sleep section in the NHP instrument both before surgery and at 1 month post-operatively.

CONCLUSIONS: In the immediate period following CABG, there is a change in distribution of sleep, with reduction in nocturnal sleep duration and an increase in daytime sleep, which had almost returned to pre-operative values 1 month after surgery. QoL scores were improved 6 months after surgery. This study demonstrates the importance of careful assessment of sleep and sleep disturbances for more individualized nursing care in order to promote sleep in the immediate post-operative period.

Place, publisher, year, edition, pages
Wiley, 1999
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54549 (URN)10.1046/j.1365-2648.1999.01006.x (DOI)10320506 (PubMedID)
Available from: 2010-03-23 Created: 2010-03-23 Last updated: 2017-12-12
5. Anxiety, depression and sleep in male patients undergoing coronary artery bypass surgery
Open this publication in new window or tab >>Anxiety, depression and sleep in male patients undergoing coronary artery bypass surgery
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
Keyword
Anxiety, · coronary artery bypass surgery, moad, personality, sleep
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28414 (URN)13551 (Local ID)13551 (Archive number)13551 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13

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