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Sleep in patients with coronary artery disease: a polysomnographic study
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.
(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.


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
URN: urn:nbn:se:liu:diva-54548OAI: diva2:305261
Available from: 2010-03-23 Created: 2010-03-23 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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Edéll-Gustafsson, Ulla
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