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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
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
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 [en]
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: urn:nbn:se:liu:diva-76681ISBN: 978-91-7393-029-1 (print)OAI: oai:DiVA.org:liu-76681DiVA: diva2:515825
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
List of papers
1. Perceptions of how sleep is influenced by rest, activity and health in patients with coronary heart disease: A phenomenographical study
Open this publication in new window or tab >>Perceptions of how sleep is influenced by rest, activity and health in patients with coronary heart disease: A phenomenographical study
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2007 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 4, 467-475 p.Article in journal (Refereed) Published
Abstract [en]

A framework is needed for identifying internal and external factors essential for the nursing management of psychological supportive health care and education for patients' self-care in sleep. In order to generate more knowledge from the patient's perspective, the aim of this study was to describe how patients with coronary artery disease (CAD) perceive that their sleep is influenced by rest, activity and health in outpatient care. Qualitative interviews were performed with 33 outpatients. The data were analysed using a phenomenographic method. Three descriptive categories of the phenomenon were described: my lifestyle is reflected in my sleep behaviour, handling the practices around tiredness and sleep, and feelings of negative and positive efficacy. Feelings of tiredness, fatigue and sleepiness were different pre-sleep stages, but were also related to the patient's adaptation and recovery. Creating one's own personal time and feelings of efficacy gave an inner sense of strength which is indicated as being particularly important in managing stress and the demands of everyday life in a satisfactory manner. From a contextual, holistic perspective on health, it is important to identify the patient's needs, symptoms and intentional or unintentional self-care management strategies regarding sleep and lifestyle. To promote a positive health outcome it is essential to identify sleeplessness behaviour and perceived self-efficacy for self-care in sleep. © 2007 Nordic College of Caring Science.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-40566 (URN)10.1111/j.1471-6712.2007.00496.x (DOI)53493 (Local ID)53493 (Archive number)53493 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
2. Sleep, arousal and health-related quality of life in men and women with coronary artery disease.
Open this publication in new window or tab >>Sleep, arousal and health-related quality of life in men and women with coronary artery disease.
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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
Keyword
arousal, coronary artery disease, gender, health-related quality of life, insomnia, nurses, nursing, sleep quality
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-70130 (URN)10.1111/j.1365-2702.2011.03787.x (DOI)000295096700011 ()
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
3. Sleep-wake-activity rhythm and health-related quality of life among patients with coronary artery disease and in a population-based sample –an actigraphy and questionnaire study
Open this publication in new window or tab >>Sleep-wake-activity rhythm and health-related quality of life among patients with coronary artery disease and in a population-based sample –an actigraphy and questionnaire study
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The aim of this study was to explore whether there are gender differences in sleep and health related quality of life in patients with coronary artery disease CAD and a matched population-based sample and to see how subjectively rated sleep is associated with actigraphy. Secondly, whether factors that predict patients´ sleep quality could be identified. Fifty-seven patients with stable CAD and forty-seven participants from a population-based sample were included. All participants completed the Uppsala Sleep Inventory (USI), the Epworth Sleepiness Scale and the SF-36. Actigraphy recordings and a sleep diary were performed for 7 days. Multiple stepwise regression analysis showed that sleep duration, sleep onset latency, nocturnal awakenings, vitality (SF-36) and BMI explained 60% of the sleep quality outcome (USI) (P<0.0001). Sleep duration, sleep efficiency and fragmentation index assessed with actigraphy and sleep diary accounted for 36% of the sleep quality outcome (diary, P<0.0001). The result can form the basis for a non-pharmacological, self-care programme supported and led by nurses.

 

Keyword
Actigraphy, coronary artery disease, health related quality of life, sleep quality, sleep-activity rhythm.
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76678 (URN)
Available from: 2012-04-16 Created: 2012-04-16 Last updated: 2012-04-17Bibliographically approved
4. Evaluation of an individualized non-pharmacological programme to promote self-care in sleep-activity in patients with coronary artery disease - a randomized intervention pilot study
Open this publication in new window or tab >>Evaluation of an individualized non-pharmacological programme to promote self-care in sleep-activity in patients with coronary artery disease - a randomized intervention pilot study
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aim. This randomized intervention pilot study aimed to evaluate the effectiveness of an individualized non-pharmacological programme to promote self-care in sleep-activity in patients with coronary artery disease (CAD) following treatment.

Background. Recent scientific findings have shown that physical exercise and stress interfere with CAD patients' sleep quality and sleep efficiency independent of gender, age and co-morbidity.

Methods. A pretest- posttest control design. Fifty-three CAD patients were randomized to either an intervention group (I-group) or to a control group (C-group) 3 to 7 weeks after treatment. They filled in questionnaires, kept a sleep diary and performed actigraphy for 10 days, with a follow-up after 3-4 months. The I-group underwent an individualized non-pharmacological education programme to promote self-care of sleep-activity led by a nurse. Individual advice on physical training, relaxation exercise and a CD-based relaxation programme were provided by a physiotherapist. Both groups received a brochure about sleep and stress.

Results: At a 3-4 month follow-up results indicated that the interventions improved patients’ sleep quality, sleep duration and sleep efficiency. In the I-group the main improvements were seen in sleep quality, sleep duration and SE% in the sleep diary for 10 days and SE% in actigraphy. Statistical improvements in HRQoL were revealed. This was not so obvious in the control group.

Conclusions: These preliminary findings suggest that an individualized non-pharmacological programme to promote self-care of sleep-activity including relaxation in patients with CAD supported by a nurse can improve sleep quality. However,

Keyword
actigraphy, coronary artery disease, health, nursing, pretest-posttest control group design, self-care, sleep-activity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76680 (URN)
Available from: 2012-04-16 Created: 2012-04-16 Last updated: 2012-04-17Bibliographically approved

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