Learning Objective #1: Describe fatigue and related symptoms experienced by women who underwent hysterectomies

Learning Objective #2: Examine relationships between women's fatigue experience and their physiologic and social factors before hysterectomy and at three and six weeks after surgery

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Sleep disturbance and fatigue are distressful symptoms for women after hysterectomy. This prospective study explored fatigue and related symptoms in culturally diverse women who underwent hysterectomy and examined relationships between their symptoms and psychosocial variables before hysterectomy and at three and six weeks after surgery. The participants were women with their ages between 35 and 81 years old undergoing elective abdomial hysterectomy or laparoscopic hysterectomy at two university hospital systems in the north-western part of California. Data were collected using objective actigraph monitoring as well as self-report questionnaires. The participants worn wrist actigraphs for 48 hours that sensed the motion, quantified the numbers of movements over a preprogrammed period of interval and recorded the data. This computer programmed actigraph was used to obtain reliable and valid measures of activity and sleep patterns of participants. Women reported significantly higher sleep disturbance three weeks after surgery compared to baseline and six weeks after surgery. Hispanic and African Americans scored higher on sleep disturbance and pain compared to European Americans. Hispanic women also scored high on fatigue compared to the other ethnic groups. Objective data from wrist actigraphy revealed an increase in awakenings and a decrease in sleep efficiency over time, and younger women experienced more sleep disturbance than older women. Level of education was positively related to preoperative fatigue severity. Higher fatigue was associated with self-reported sleep disturbance and depressed mood. In addition, self-reported sleep disturbance was negatively correlated with objective sleep efficiency pre-operatively as well as postoperatively. Findings suggest that complaints of fatigue and/or depression during the postoperative period should be evaluated in light of potential sleep disturbances, particularly in younger, more educated women who appear to be at increased risk.