Sleep, psychological symptoms and quality of life in patients undergoing coronary artery bypass grafting

Abstract

In this thesis sleep, psychological symptoms and quality of life (Qol) in patients undergoing coronary artery bypass grafting (CABG) at the University Hospital in Linköping were evaluated. Interviews and 24-hour polysomnography were performed prior to surgery, immediately after surgery and again at one month, with a six-monthfollow-up mailed questionnaire. Habitual sleep was evaluated using the Uppsala Sleep Inventory questionnaire and a diary the recorded mornings. The Spielberger State of Anxiety Scale and the Zung´s Self-rating Depression Scale were used to measure anxiety and depression, respectively. Physical functional capacity was assessed according to the New York Heart Association´s (NYHA) classes and Qol, with the Nottingham Health Profile instrument (NHP).A retrospective evaluation of nurse's documentation about sleep was also performed. In addition, the quality and quantity of sleep were assessed before surgery and in the immediate postoperative period in a pilot study, with a one-month follow-up interview. The results indicated disturbed sleep, and changes in behaviour and mental state after surgery due to fragmented sleep, pain and anxiety.Forty-four patients were examined prior to surgery. The results showed that almost two-fifths experienced too little sleep habitually and 50 % had a combination of at least two sleep problems. Poorer health, higher level of anxiety and increased difficulties maintaining sleep (DMS) were consistent with significantly longer sleep latency, increased fragmented sleep, and reduced stages 3 and 4 and REM sleep measured by polysomnography. The level of Qol on the NHP was significantly associated with objectively measured sleep.In the immediate period following CABG there is a changed distribution of sleep, with a reduction of nocturnal sleep duration and an increase in daytime sleep, which had almost returned to preoperative values one month after surgery. Qol was significantly improved six months after surgery compared to before surgery.It was noted that patients with a more anxiety prone reactivity during six months following CABG had significantly more sleep disturbances, reduced energy and functional physical capacity, and lower quality of life, compared to those without such reactivity. Significantly more sleep disturbances, reduced energy and lower quality of life were more prominent among those with sadness/depression or cognitive/behavioural fatigue as reactions to sleep loss. A higher degree of cognitive/behavioural fatigue and dysphoria reactions were associated with a higher NYHA class.In conclusion, patients with coronary artery disease have poor quantity and quality of sleep. Increased psychological symptoms in patients with CAD prior to surgery were associated with greater symptoms six months after surgery. Physical functional capacity and quality of life were significantly improved six months after surgery

Sleep and partner-specific quality of life in partners of men with lower urinary tract symptoms compared with partners of men from the general population

“…The quantity and quality of sleep were assessed by six questions from the Uppsala Sleep Inventory (USI) [17,18] and 19 questions from the Basic Nordic Sleep Questionnaire (BNSQ) [19]. The questions referred to the past 3 months, with regard to sleeponset latency, time of going to bed/waking up, nocturnal sleep duration and pharmacological therapy.…”

“…Sleep quality was evaluated as "How have you slept the past three months? ", rated on a five-point scale from 1 (well) to 5 (badly) [17][18][19].…”

“…Clinical insomnia was defined as difficulties falling asleep on three to five days or more a week, sleeponset latency or wakefulness after sleep onset of longer than 30 min, nocturnal awakenings on more than three nights a week, awakenings five times or more a night or early morning awakenings more than three times a week combined with one or more day-time symptoms. The requirement for day-time symptoms was that the subject had excessive morning sleepiness, day-time sleepiness, physical tiredness or non-restorative sleep on three to five days or more a week [17][18][19]21].…”

Temporal sleep patterns between healthy and depressed individuals

“…Sleep enhances the physical restoration of the body [1] and re-establishes the mind. Indeed, sleep is an important life-style factor that contributes to the overall health and well being.…”

What about the parents? : Sleep quality, mood, saliva cortisol response and sense of coherence in parents with a child admitted to pediatric care

“…Several reasons could be stated in the response. The sleep log has been validated against polysomnography (Edéll-Gustafsson, 1999) and has been used previously to measure sleep over time (Johansson et al, 2013).…”