Fragmented sleep and tiredness in males and females one year after percutaneous transluminal coronary angioplasty (PTCA).

AIM: Reported sleep quality was examined in relation to anxiety, depression, selected psycho-physiological sleep disturbing symptoms, daytime dysfunctions according to poor sleep, and quality of life 1 year after percutaneous transluminal coronary angioplasty (PTCA). Furthermore, females were compared with age-matched males to examine any differences in sleep quality, psycho-physiological symptoms and quality of life. STUDY DESIGN: A descriptive comparative study. SAMPLE: Twenty-two females, mean age 62.7 (SD 5.7) and 70 men, mean age 60.4 (SD 6.7), were consecutively recruited. METHOD: A mailed questionnaire was distributed, including the Uppsala Sleep Inventory, Spielberger State Anxiety scale, Zung's Self-rating Depression Scale and the Nottingham Health Profile instrument. RESULTS: Forty-six per cent of the patients had a history of myocardial infarction and 40.2% hypertension. Seventy-two per cent of the patients were anxious and 30.4% depressed. Difficulty in getting to sleep was related to intrusive thoughts with increased feelings of anxiety and sensitivity. Difficulty in maintaining sleep was the most common sleep complaint (42.4%) and physical tiredness/fatigue was the greatest consequence of disturbed sleep (51.1%). Those with pain, palpitations or respiratory nocturnal sleep-disturbing symptoms were characterised by shorter sleep duration, emotional distress, cognitive dysfunction, tiredness and reduced quality of life. Greater difficulties initiating sleep and worse health related quality of life were revealed in females compared with aged-matched males. CONCLUSION: Fragmented sleep is a problem partly because of psycho-physiological symptoms 1 year after PTCA, with reduced resilience to stress, increasing vulnerability or diminished coping ability and poorer quality of life.

Sleep and quality of life assessment in patients undergoing coronary artery bypass grafting.

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.

Anxiety, depression and sleep in male patients undergoing coronary artery bypass surgery.

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.

Measurement of sleep and quality of life before and after coronary artery bypass grafting: a pilot study.

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.