Objective and Subjective Characteristics of Sleep after Coronary Artery Bypass Graft Surgery in the Early Period: A Prospective Study with Healthy Subjects
Background. The purpose of this study was to investigate changes in sleep characteristics by examining both subjective tests and objective parameters such as actigraphic sleep analysis in patients who underwent coronary artery bypass graft surgery (CABG).
Patients and Methods. Forty-five patients who underwent CABG operations and did not have any sleep disturbance were examined. They were evaluated by subjective and objective sleep parameters at the beginning of the examination and on the fifth postoperative day. Forty healthy subjects who did not undergo the operation were also evaluated.
Results. The Pittsburgh Index and Epworth values in the postoperative group were significantly higher, but Maintenance of Wakefulness Test lengths were significantly shorter than in the preoperative and control groups. Sleep latency, napping episodes, total napping periods, and fragmentation index values of the postoperative group were significantly higher, but sleep efficiency values were significantly lower than in the preoperative and control groups.
Conclusion. The cause of sleeplessness after CABG surgery may be the temporary deterioration of circulation in the centers of the brain stem and hypothalamus, which control sleep and awakening. It can be proposed that the improvement of the circulation in these centers a couple of months after the operation help to regain sleep control, and thus sleep disturbances disappear.
Carskadon MA, Dement WC. 1994. Normal human sleep: an overview. In: Krieger MH, Roth T, Dement WC. Principles and Practice of Sleep Medicine. 2nd ed. Philadelphia, PA: WB Saunders; 18-25.nChocron S, Tatou E, Schjoth B, et al. 2000. Perceived health status in patients over 70 before and after open-heart operations. Age Ageing 29:329-34.nEdell-Gustaffson UM, Hetta JE. 1999. Anxiety, depression, and sleep in male patients undergoing coronary artery bypass surgery. Scand J Car Sci 13:137-43.nHayter J. 1983. Sleep behaviors of older persons. Nurs Res 32:242-6.nHunt JO, Hendrata MV, Myles P. 2000. Quality of life 12 months after coronary artery bypass graft surgery. Heart Lung 29:401-11.nKarchman SL, D'Alonzo GE, Criner GJ. 1995. Sleep in the intensive care units. Chest 107:1713-20.nKing KB, Parinello KA. 1988. Patient perceptions of recovery from coronary artery bypass grafting after discharge from the hospital. Heart Lung 17:708-15.nKnapp-Spooner C, Yarcheski A. 1992. Sleep patterns and stress in patients having coronary bypass. Heart Lung 21:342-9.nLockley S, Skene D, Arendt J. 1999. Comparison between subjective and actigraphic measurement of sleep and sleep rhythms. J Sleep Res 8:175-83.nLukkarinen H. 1998. Quality of life in coronary artery disease. Nurs Res 47:337-43.nMonk TH, Buysse DJ, Kennedy KS, Pods, JM, De Grazia JM, Miewald JM. 2003. Measuring sleep habits without using a diary: the sleep timing questionnaire. Sleep 26:208-12.nPlomondon ME, Cleveland JC, Ludwig ST, et al. 2001. Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes. Ann Thorac Surg 72:114-9.nRedeker NS. 1993. Symptoms reported by older and middle-aged adults after coronary bypass surgery. Clin Nurs Res 2:148-59.nRedeker NS, Mason DJ, Wykpisz E, Glica B. 1996. Sleep patterns in women after coronary artery bypass surgery. Appl Nurs Res 9:115-22.nRedeker NS, Wykpisz EM. 2001. Effects of age on sleep after coronary artery bypass surgery. In: American Thoracic Society Annual Scientific Sessions Proceedings. San Francisco, CA: American Thoracic Society.nRedeker NS, Hedges C. 2002. Sleep during hospitalization and recovery after cardiac surgery. J Cardiovasc Nurs 17:56-68.nRedeker NS, Ruggiero JS, Hedges C. 2004. Sleep is related to physical function and emotional well-being after cardiac surgery. Nursing Research 53:154-62.nReyner A, Horne JA. 1995. Gender- and age-related differences in sleep determined by home-recorded sleep logs and actimetry from 400 adults. Sleep 18:127-34.nSadeh A, Hauri PJ, Kripke DF, Lavie P. 1995. The role of actigraphy in the evaluation of sleep disorders. Sleep 18:288-302.nSchaefer KM, Swavely D, Rothenberger C, Hess S, Williston D. 1996. Sleep disturbances post coronary artery bypass surgery. Prog Cardiovasc Nurs 11:5-14.nSchmitt FA, Phillips BA, Cook YR, Berry DTR, Wekstein DR. 1996. Self-report of sleep symptoms in older adults: Correlates of daytime sleepiness and health. Sleep 19:59-64.nSimpson T, Lee E. 1996. Individual factors that influence sleep after cardiac surgery. Am J Crit Care 5:182-9.nTack BB, Gillis CL. 1990. Nurse-monitored cardiac recovery: a description of the first 8 weeks. Heart Lung 19:491-9.n