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Sleep and quality of life assessment in patients undergoing coronary artery bypass grafting
U M Edéll-Gustafsson1, J E Hetta, C B Arén
1Department of Medicine and Care, Division of Nursing Science, Faculty of Health Sciences in Linköping, Linköping, Sweden. ulla.edell-gustafsson@hul.liu.se
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.