Follow-up With Objective and Subjective Tests of the Sleep Characteristics of Patients After Cardiac Surgery

Abstract

Background The purpose of this study was to investigate the changes in sleep characteristics in patients who underwent coronary artery bypass grafting (CABG) surgery, using both subjective and objective tests in the early (preoperative) and late (postoperative) periods. Methods and Results Forty-five patients who underwent CABG and did not previously have any sleep disturbance were evaluated by subjective and objective sleep parameters during a consecutive 3-5-day preoperative examination, during a consecutive 5-8-day period in the 1 st postoperative week, and during consecutive 5-8-day periods in the 1 st and 2 nd postoperative months. The Pittsburgh Index and Epworth Sleepiness Scale values, sleep latency, napping episodes, total napping period, duration of wakefulness after sleep onset and fragmentation index values were significantly increased; however, Maintenance of Wakefulness Test lengths, total sleep time and sleep efficiency were significantly decreased in the 1 st postoperative week. All of these were the same in the 1 st postoperative month and differences were not statistically different from the preoperative period. None of the sleep parameters in the 2 nd postoperative month differed from the values obtained in the preoperative period. Conclusion The cause of sleeplessness after CABG surgery may be temporary deterioration of circulation in the centers of the brain stem and hypothalamus that control sleep and awakening. Improvement of the circulation in these centers a few months after the operation helps to regain sleep control, and thus sleep disturbances disappear. (Circ J 2007; 71: 1506 -1510

Actigraphy for Measurement of Sleep and Sleep-Wake Rhythms in Relation to Surgery

“…Of the 24 studies in which actigraphy was used to assess sleep, 9 studies were in patients undergoing cardiac surgery, [25][26][27],31-36 6 general surgery, 2,[22][23][24]37,38 5 outpatient surgery, 39-43 2 breast surgery, 44,45 and the last 2 studies involved gynecological/obstetric surgery. 46,47 Three studies were randomized clinical trials.…”

“…The smallest study included 11 patients, and the largest included 169 patients. In 12 studies there was a control group 22,[24][25][26][27]32,[40][41][42][43]46,47 ; 5 of these studies included healthy controls. 22,26,27,40,41 In 23 of the 24 studies, total sleep time/nighttime sleep was assessed by actigraphy ( Table 1).…”

“…In the 9 studies including patients undergoing cardiac surgery, [25][26][27][31][32][33][34][35][36] the population size was 13-129. Most of the procedures were coronary artery bypass surgery [25][26][27][32][33][34][35][36] ; one was placement of a left ventricular assist device through an open procedure.…”

“…Most of the procedures were coronary artery bypass surgery [25][26][27][32][33][34][35][36] ; one was placement of a left ventricular assist device through an open procedure. 31 Six of the 9 studies included both preoperative and postoperative values, [25][26][27]31,34,35 with only postoperative values in the remaining 3 studies. 32,33,36 When using actigraphy to assess sleep after cardiac surgery, it was shown that total sleep time was reduced in the first week after surgery.…”

Frequência de sonolência diurna e apneia obstrutiva do sono em pacientes submetidos à cirurgia cardíaca participantes de um Programa de Reabilitação Cardiorrespiratória

“…Cabe ressaltar, que entre os sintomas ocasionados por estes distúrbios estão à insônia, a má qualidade do sono, os despertares noturnos frequentes e matinais (REDEKER; HEDGES, 2002;YILMAZ;ISKESEN, 2007;DIANATKHAH et al, 2015). A privação do sono pode gerar mudanças significativas nos mecanismos da regulação da função cardiovascular, com impacto importante no desenvolvimento de DCVs (TUFIK, 2008;DETTONI, 2008).…”