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Sleep and quality of life assessment in patients undergoing coronary artery bypass grafting
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
Sleep Disorders Unit, University Hospital, Uppsala.
Östergötlands Läns Landsting, Heart Centre, Department of Cardiology Thoracic Radiology.
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. Vol. 29, no 5, 1213-1220 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-54549DOI: 10.1046/j.1365-2648.1999.01006.xPubMedID: 10320506OAI: oai:DiVA.org:liu-54549DiVA: diva2:305266
Available from: 2010-03-23 Created: 2010-03-23 Last updated: 2017-12-12
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.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 584
Keyword
Sleep, polysomnography, coronary disease, surgery, anxiety, psychophysiological disorders, personality
National Category
Medical and Health Sciences
Identifiers
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)
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Note
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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