Saturday, July 24, 2004
This presentation is part of : Medical/Surgical Nursing
Patterns and Predictors of Sleep Disturbance After Cardiac Surgery
Nancy S. Redeker, MSN, PhD, RN, School of Nursing, University of Medicine and Dentistry of NJ, Newark, NJ, USA, Jeanne Ruggiero, MS, PhD, RN, College of Nursing, Rutgers University, Newark, NY, USA, and Christine Hedges, MSN, PhD, RN, Department of Nursing, The William Paterson University, Wayne, NJ, USA.
Learning Objective #1: Relate factors that predict sleep disturbance after cardiac surgery
Learning Objective #2: Discuss changes in sleep patterns after cardiac surgery

Background: Sleep pattern disturbance is common after cardiac surgery. However, little is known about changes in sleep patterns over the course of recovery or the extent to which sleep pattern disturbance is influenced by pre-operative sleep patterns. This information is necessary to focus decision-making about the types and timing of sleep-promoting interventions during the course of hospitalization and recovery. Objectives: To examine changes in sleep patterns over eight weeks of recovery after cardiac surgery and the contributions of pre-operative sleep to post-operative sleep pattern disturbance during the first, fourth, and eighth postoperative weeks. Methods: A repeated measures design was used. Seventy-two cardiac surgery patients wore wrist actigraphs and completed sleep diaries for 3 days at each of 4 time periods: pre-operative period (T1), first (T2), fourth (T3), and eighth (T4) post-operative weeks. They completed the Pittsburgh Sleep Quality Index during the pre-operative and fourth and eighth post-operative weeks. Daily sleep pattern variables were computed from the actigraph data and averaged over each 3-day study period. Findings: Sleep pattern disturbance was prevalent from the pre-operative period throughout the eighth week after cardiac surgery, as demonstrated by self-reported and actigraph-recorded sleep variables. Sleep was most disturbed during the first post-operative week and improved over the fourth and eighth postoperative weeks. Daytime sleep duration and self-reported sleep returned to pre-operative levels at eight weeks. Sleep efficiency and duration were lower, and nocturnal activity were higher at eight weeks than at baseline. Age, gender, pre-operative New York Heart Association Functional class and preoperative sleep pattern variables explained 20 to 50 percent of the variance in post-operative sleep. Conclusions: Sleep disturbance is a dynamic, multidimensional phenomenon that is present pre-operatively and continues during the post-operative period. Evaluation of pre-operative sleep patterns may be useful in identifying patients at highest risk of post-operative sleep disturbance.

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Sigma Theta Tau International
July 22-24, 2004