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Sleep, arousal and health-related quality of life in men and women with coronary artery disease.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.ORCID iD: 0000-0002-2608-2062
Hjärtkliniken, Kärnsjukhuset i Skövde.
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2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 19-20, 2787-2801 p.Article in journal (Refereed) Published
Abstract [en]

Aim. To evaluate whether there are gender differences in insomnia, sleep quality, sleep efficiency (%), general arousal, disease-specific and health-related quality of life in patients with coronary artery disease, compared with an age- and gender-matched randomly selected group from the general population.

Background.  There are gender difference effects of sleep disturbances in the general population, but this perspective among patients with coronary artery disease has been poorly analysed.

Design.  In this prospective study, comparative, descriptive and model testing designs were used.

Method.  The patients with coronary artery disease, 556 men and 324 women aged 25–86, were compared with a matched population-based group. Data were collected by validated and reliability-tested questionnaires.

Results.  The prevalence of severe insomnia varied between 17–44% in all four groups. The severe insomniac coronary artery disease patients displayed a two- or threefold higher presleep arousal, had two hours shorter nocturnal sleep duration/night and were more limited in their physical exercise level than the population-based group. Gender differences in sleep quality, sleep efficiency (%) and general arousal disappeared with increased insomnia severity.

Conclusions.  Independent of gender, age and comorbidity, physical exercise, general arousal behaviour and delayed poststress recovery after mental stress were found to have a negative impact on the coronary artery disease patients’ sleep quality and sleep efficiency (%), interfering with their health-related quality of life. The variables significantly explained 41% of the sleep quality outcome and 29% of the sleep efficiency (%).

Relevance to clinical practice.  Insomnia because of hyperarousal behaviour can be an important factor in the development of an individual self-care management programme supported by a healthcare team.

Place, publisher, year, edition, pages
Blackwell , 2011. Vol. 20, no 19-20, 2787-2801 p.
Keyword [en]
arousal, coronary artery disease, gender, health-related quality of life, insomnia, nurses, nursing, sleep quality
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-70130DOI: 10.1111/j.1365-2702.2011.03787.xISI: 000295096700011OAI: oai:DiVA.org:liu-70130DiVA: diva2:435738
Note
Funding Agencies|Swedish Research Council (Vr)| 2001-504-338-37 |Ostergotland County Council| F2002-218 |Research and Development unit at Skaraborg Hospital, Sweden| VGSKAS-9122 |Available from: 2011-08-19 Created: 2011-08-19 Last updated: 2017-12-08
In thesis
1. Sleep-Wake-Activity and Health-Related Quality of Life in Patients with Coronary Artery Disease and evaluation of an individualized non-pharmacological programme to promote self-care in sleep
Open this publication in new window or tab >>Sleep-Wake-Activity and Health-Related Quality of Life in Patients with Coronary Artery Disease and evaluation of an individualized non-pharmacological programme to promote self-care in sleep
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Sleep is a basic need, important to physical and psychological recovery. Insomnia implies sleep-related complaints, such as difficulty falling asleep, difficulty staying asleep, early awakening, or non-restorative sleep (NRS) in an individual who has adequate circumstances and opportunity to sleep.  Insomnia is also related to impairment of daytime functions. The prevalence of reported sleep disturbances varies between 15% and 60% in patients with coronary artery disease (CAD) up to five years after intervention. Disturbed sleep may have a negative impact on self-care capacity and behaviours. Little attention has been given to evaluation of sleep promotion through individualized non-pharmacological interventions among CAD patients.

The overall aim of this thesis was to describe the impact of sleep quality and disrupted sleep on health-related quality of life (HRQoL) in patients with stable CAD, in comparison to a population-based group. The objective was also to evaluate an individualized non-pharmacological programme to promote self-care in sleep.

Four studies were conducted during seven years, starting in 2001. Patients from six hospitals in the south of Sweden were invited to participate. In addition, an age and gender matched population-based group was randomly selected during the same period as the patients and was used for comparison with the CAD patients in two of the studies. Data was collected through interviews, self-reported questionnaires, a study specific sleep diary and actigraphy registrations. A pretest-posttest control design was used to evaluate whether an individualized non-pharmacological intervention programme could promote self-care in sleep-activity in CAD patients.

The results showed a high prevalence of insomniac CAD patients out of whom a large proportion were non-rested insomniacs. This showed that NRS is one of the core symptoms of insomnia. On the other hand there were weak or non-significant gender differences with increasing insomnia severity. Severe insomniac CAD patients displayed a two or threefold higher presleep arousal or anxiety score and were more limited in taking physical exercise than the general population. Generally low sleep efficiency (SE%) was revealed in the studies, particularly among severe non-rested insomniac CAD patients.

Among CAD patients, the individualized non-pharmacological programme to promote self-care in sleep-activity indicated improvements in sleep and HRQoL.

This thesis elucidates the importance of focusing on the individual’s perception of their sleep-activity and health in their local context and supporting self-care management. Furthermore, it is of importance that nurses set individual goals together with the patient in order to increase self-efficacy to promote HRQoL.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 107 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1272
Keyword
Actigraphy, coronary artery disease, health-related quality of life, insomnia, non-pharmacological programme, nursing, self-care management, sleep-activity, sleep quality
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76681 (URN)978-91-7393-029-1 (ISBN)
Public defence
2012-04-03, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-04-17 Created: 2012-04-16 Last updated: 2012-07-09Bibliographically approved

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Johansson, AnnaSvanborg, EvaSwahn, EvaEdéll-Gustafsson, Ulla

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Johansson, AnnaSvanborg, EvaSwahn, EvaEdéll-Gustafsson, Ulla
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Nursing ScienceFaculty of Health SciencesClinical NeurophysiologyDepartment of Neurophysiology UHLCardiologyDepartment of Cardiology UHL
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