Annals of Behavioral Medicine

, Volume 47, Issue 3, pp 347–357 | Cite as

Preoperative Sleep Complaints Are Associated with Poor Physical Recovery in the Months Following Cardiac Surgery

  • Lydia Poole
  • Tara Kidd
  • Elizabeth Leigh
  • Amy Ronaldson
  • Marjan Jahangiri
  • Andrew Steptoe
Original Article

Abstract

Background

Sleep disturbance is associated with poorer outcomes in cardiac patients, but little is known about the independent role of sleep quality in coronary artery bypass graft (CABG) patients.

Purpose

This study aims to examine the relationship between preoperative sleep complaints and post-operative emotional and physical recovery in CABG surgery patients, independently of demographic, clinical and mood factors.

Methods

Two hundred thirty CABG patients (aged 67.81 ± 9.07 years) completed measures of self-reported sleep complaints before surgery and health-related quality of life (HRQoL), physical symptoms and pain 2 months after surgery.

Results

Greater sleep complaints prior to surgery were associated with greater physical symptoms, poorer physical HRQoL and greater sensory pain after surgery (p < 0.05), but not with affective pain or mental HRQoL. Preoperative mood was not able to explain these associations.

Conclusions

Sleep complaints may be implicated in physical recovery from CABG surgery but further work is needed to understand the role of causal pathways.

Keywords

Sleep Coronary artery bypass graft surgery Depression Health-related quality of life Recovery 

Notes

Acknowledgments

This research was funded by the British Heart Foundation.

Conflict of Interest

The authors have no conflict of interest to disclose.

References

  1. 1.
    Hawkes AL, Mortensen OS. Up to one third of individual cardiac patients have a decline in quality of life post-intervention. Scand Cardiovasc J. 2006; 40(4): 214-218.PubMedCrossRefGoogle Scholar
  2. 2.
    Covinsky KE, Lin F, Bittner V, Hlatky MA, Knight SJ, Vittinghoff E. Health-related quality of life following coronary artery bypass graft surgery in post-menopausal women. J Gen Intern Med. 2008; 23(9): 1429-1434.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Moore SM. A comparison of women's and men's symptoms during home recovery after coronary artery bypass surgery. Heart Lung. 1995; 24(6): 495-501.PubMedCrossRefGoogle Scholar
  4. 4.
    Parry M, Watt-Watson J, Hodnett E, Tranmer J, Dennis C-L, Brooks D. Pain experiences of men and women after coronary artery bypass graft surgery. J Cardiovasc Nurs. 2010; 25(3): E9-E15.PubMedCrossRefGoogle Scholar
  5. 5.
    Zimmerman L, Barnason S, Young L, Tu C, Schulz P, Abbott AA. Symptom profiles of coronary artery bypass surgery patients at risk for poor functioning outcomes. J Cardiovasc Nurs. 2010; 25(4): 292-300.PubMedCrossRefGoogle Scholar
  6. 6.
    Leineweber C, Kecklund G, Janszky I, Akerstedt T, Orth-Gomér K. Poor sleep increases the prospective risk for recurrent events in middle-aged women with coronary disease. The Stockholm Female Coronary Risk Study. J Psychosom Res. 2003; 54(2): 121-127.PubMedCrossRefGoogle Scholar
  7. 7.
    Sabanayagam C, Shankar A. Sleep duration and cardiovascular disease: Results from the National Health Interview Survey. Sleep. 2010; 33(8): 1037-1042.PubMedCentralPubMedGoogle Scholar
  8. 8.
    Schwartz SW, Cornoni-Huntley J, Cole SR, Hays JC, Blazer DG, Schocken DD. Are sleep complaints an independent risk factor for myocardial infarction? Ann Epidemiol. 1998; 8(6): 384-392.PubMedCrossRefGoogle Scholar
  9. 9.
    Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: A systematic review and meta-analysis of prospective studies. Eur Heart J. 2011; 32(12): 1484-1492.PubMedCrossRefGoogle Scholar
  10. 10.
    Eaker ED, Pinsky J, Castelli WP. Myocardial infarction and coronary death among women: Psychosocial predictors from a 20-year follow-up of women in the Framingham Study. Am J Epidemiol. 1992; 135(8): 854-864.PubMedGoogle Scholar
  11. 11.
    Mallon L, Broman JE, Hetta J. Sleep complaints predict coronary artery disease mortality in males: A 12-year follow-up study of a middle-aged Swedish population. J Intern Med. 2002; 251(3): 207-216.PubMedCrossRefGoogle Scholar
  12. 12.
    Nilsson PM, Nilsson JA, Hedblad B, Berglund G. Sleep disturbance in association with elevated pulse rate for prediction of mortality—consequences of mental strain? J Intern Med. 2001; 250(6): 521-529.PubMedCrossRefGoogle Scholar
  13. 13.
    Chandola T, Ferrie JE, Perski A, Akbaraly T, Marmot MG. The effect of short sleep duration on coronary heart disease risk is greatest among those with sleep disturbance: A prospective study from the Whitehall II cohort. Sleep. 2010; 33(6): 739-744.PubMedCentralPubMedGoogle Scholar
  14. 14.
    Jenkins CD, Jono RT, Stanton BA. Predicting completeness of symptom relief after major heart surgery. Behav Med. 1996; 22(2): 45-57.PubMedCrossRefGoogle Scholar
  15. 15.
    Redeker NS, Hedges C. Sleep during hospitalization and recovery after cardiac surgery. J Cardiovasc Nurs. 2002; 17(1): 56-68. quiz 82–83.PubMedCrossRefGoogle Scholar
  16. 16.
    Hunt JO, Hendrata MV, Myles PS. Quality of life 12 months after coronary artery bypass graft surgery. Heart Lung. 2000; 29(6): 401-411.PubMedCrossRefGoogle Scholar
  17. 17.
    Redeker NS, Ruggiero JS, Hedges C. Sleep is related to physical function and emotional well-being after cardiac surgery. Nurs Res. 2004; 53(3): 154-162.PubMedCrossRefGoogle Scholar
  18. 18.
    Edéll-Gustafsson UM, Hetta JE. Anxiety, depression and sleep in male patients undergoing coronary artery bypass surgery. Scand J Caring Sci. 1999; 13(2): 137-143.PubMedGoogle Scholar
  19. 19.
    Blumenthal JA, Lett HS, Babyak MA, et al. Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet. 2003; 362(9384): 604-609.PubMedCrossRefGoogle Scholar
  20. 20.
    Roques F, Michel P, Goldstone AR, Nashef SAM. The logistic EuroSCORE. Eur Heart J. 2003; 24(9): 881-882.PubMedCrossRefGoogle Scholar
  21. 21.
    Goldstone T. How to calculate the logistic EuroSCORE [Internet]. euroSCORE.org. [cited 2013 Apr 19]. Available from: http://www.euroscore.org/logisticEuroSCORE.htm
  22. 22.
    Jenkins CD, Stanton BA, Niemcryk SJ, Rose RM. A scale for the estimation of sleep problems in clinical research. J Clin Epidemiol. 1988; 41(4): 313-321.PubMedCrossRefGoogle Scholar
  23. 23.
    Steptoe A, O'Donnell K, Marmot M, Wardle J. Positive affect, psychological well-being, and good sleep. J Psychosom Res. 2008; 64(4): 409-415.PubMedCrossRefGoogle Scholar
  24. 24.
    Kumari M, Badrick E, Ferrie J, Perski A, Marmot M, Chandola T. Self-reported sleep duration and sleep disturbance are independently associated with cortisol secretion in the Whitehall II study. J Clin Endocrinol Metab. 2009; 94(12): 4801-4809.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Kudielka BM, Von Känel R, Gander M-L, Fischer JE. Effort–reward imbalance, overcommitment and sleep in a working population. Work & Stress. 2004; 18(2): 167-178.CrossRefGoogle Scholar
  26. 26.
    Jackowska M, Dockray S, Hendrickx H, Steptoe A. Psychosocial factors and sleep efficiency: Discrepancies between subjective and objective evaluations of sleep. Psychosom Med. 2011; 73(9): 810-816.PubMedCrossRefGoogle Scholar
  27. 27.
    Lyytikäinen P, Lallukka T, Lahelma E, Rahkonen O. Sleep problems and major weight gain: A follow-up study. Int J Obes (Lond). 2011; 35(1): 109-114.CrossRefGoogle Scholar
  28. 28.
    Jenkins CD, Stanton BA, Jono RT. Quantifying and predicting recovery after heart surgery. Psychosom Med. 1994; 56(3): 203-212.PubMedGoogle Scholar
  29. 29.
    Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev. 1988; 8(1): 77-100.CrossRefGoogle Scholar
  30. 30.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67(6): 361-370.PubMedCrossRefGoogle Scholar
  31. 31.
    Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34(3): 220-233.PubMedCrossRefGoogle Scholar
  32. 32.
    Jenkinson C, Layte R, Jenkinson D, et al. A shorter form health survey: Can the SF-12 replicate results from the SF-36 in longitudinal studies? Journal of Public Health. 1997; 19(2): 179-186.CrossRefGoogle Scholar
  33. 33.
    Schroter S, Lamping DL. Coronary Revascularisation oOutcome Questionnaire (CROQ): Development and validation of a new, patient based measure of outcome in coronary bypass surgery and angioplasty. Br Med J. 2004; 90(12): 1460.Google Scholar
  34. 34.
    Melzack R. The short-form McGill pain questionnaire. Pain. 1987; 30(2): 191-197.PubMedCrossRefGoogle Scholar
  35. 35.
    Hokkanen M, Järvinen O, Huhtala H, Tarkka MR. A 12-year follow-up on the changes in health-related quality of life after coronary artery bypass graft surgery. Eur J Cardiothorac Surg. 2013. doi: 10.1093/ejcts/ezt358
  36. 36.
    Peric V, Borzanovic M, Stolic R, et al. Predictors of worsening of patients' quality of life six months after coronary artery bypass surgery. J Card Surg. 2008; 23(6): 648-654.PubMedCrossRefGoogle Scholar
  37. 37.
    Cheng DC, Bainbridge D, Martin JE, Novick RJ. Evidence-Based Perioperative Clinical Outcomes Research Group. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology. 2005; 102(1): 188-203.PubMedCrossRefGoogle Scholar
  38. 38.
    Jokinen JJ, Hippeläinen MJ, Turpeinen AK, Pitkänen O, Hartikainen JEK. Health-related quality of life after coronary artery bypass grafting: A review of randomized controlled trials. J Card Surg. 2010; 25(3): 309-317.PubMedCrossRefGoogle Scholar
  39. 39.
    Thomson P, Niven CA, Peck DF, Eaves J. Patients' and partners' health-related quality of life before and 4 months after coronary artery bypass grafting surgery. BMC Nurs. 2013; 12(1): 16.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Lie I, Arnesen H, Sandvik L, Hamilton G, Bunch EH. Health-related quality of life after coronary artery bypass grafting. The impact of a randomised controlled home-based intervention program. Qual Life Res. 2009; 18(2): 201-207.PubMedCrossRefGoogle Scholar
  41. 41.
    Jenkinson C, Chandola T, Coulter A, Bruster S. An assessment of the construct validity of the SF–12 summary scores across ethnic groups. J Public Health. 2001; 23(3): 187-194.CrossRefGoogle Scholar
  42. 42.
    Almeida OP, Alfonso H, Yeap BB, Hankey G, Flicker L. Complaints of difficulty to fall asleep increase the risk of depression in later life: The health in men study. J Affect Disord [Internet]. 2011 [cited 2011 Jun 27]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/21680026
  43. 43.
    Benca RM, Obermeyer WH, Thisted RA, Gillin JC. Sleep and psychiatric disorders. A meta-analysis. Arch Gen Psychiatry. 1992; 49(8): 651-668. discussion 669–670.PubMedCrossRefGoogle Scholar
  44. 44.
    Wellenius GA, Mukamal KJ, Kulshreshtha A, Asonganyi S, Mittleman MA. Depressive symptoms and the risk of atherosclerotic progression among patients with coronary artery bypass grafts. Circulation. 2008; 117(18): 2313-2319.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Tully PJ, Baker RA, Turnbull D, Winefield H. The role of depression and anxiety symptoms in hospital readmissions after cardiac surgery. J Behav Med. 2008; 31(4): 281-290.PubMedCrossRefGoogle Scholar
  46. 46.
    Doering LV, Moser DK, Lemankiewicz W, Luper C, Khan S. Depression, healing, and recovery from coronary artery bypass surgery. Am J Crit Care. 2005; 14(4): 316-324.PubMedGoogle Scholar
  47. 47.
    Doering LV, Martínez-Maza O, Vredevoe DL, Cowan MJ. Relation of depression, natural killer cell function, and infections after coronary artery bypass in women. Eur J Cardiovasc Nurs. 2008; 7(1): 52-58.PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Morone NE, Weiner DK, Belnap BH, et al. The impact of pain and depression on recovery after coronary artery bypass grafting. Psychosom Med. 2010; 72(7): 620-625.PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    Meerlo P, Sgoifo A, Suchecki D. Restricted and disrupted sleep: Effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Med Rev. 2008; 12(3): 197-210.PubMedCrossRefGoogle Scholar
  50. 50.
    Chapotot F, Buguet A, Gronfier C, Brandenberger G. Hypothalamo-pituitary-adrenal axis activity is related to the level of central arousal: Effect of sleep deprivation on the association of high-frequency waking electroencephalogram with cortisol release. Neuroendocrinology. 2001; 73(5): 312-321.PubMedCrossRefGoogle Scholar
  51. 51.
    Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999; 354(9188): 1435-1439.PubMedCrossRefGoogle Scholar
  52. 52.
    Akerstedt T, Palmblad J, de la Torre B, Marana R, Gillberg M. Adrenocortical and gonadal steroids during sleep deprivation. Sleep. 1980; 3(1): 23-30.PubMedGoogle Scholar
  53. 53.
    Follenius M, Brandenberger G, Bandesapt JJ, Libert JP, Ehrhart J. Nocturnal cortisol release in relation to sleep structure. Sleep. 1992; 15(1): 21-27.PubMedGoogle Scholar
  54. 54.
    Ebrecht M, Hextall J, Kirtley L-G, Taylor A, Dyson M, Weinman J. Perceived stress and cortisol levels predict speed of wound healing in healthy male adults. Psychoneuroendocrinology. 2004; 29(6): 798-809.PubMedCrossRefGoogle Scholar
  55. 55.
    Vedhara K, Miles JNV, Wetherell MA, et al. Coping style and depression influence the healing of diabetic foot ulcers: Observational and mechanistic evidence. Diabetologia. 2010; 53(8): 1590-1598.PubMedCrossRefGoogle Scholar
  56. 56.
    Lusardi P, Mugellini A, Preti P, Zoppi A, Derosa G, Fogari R. Effects of a restricted sleep regimen on ambulatory blood pressure monitoring in normotensive subjects. Am J Hypertens. 1996; 9(5): 503-505.PubMedCrossRefGoogle Scholar
  57. 57.
    Tochikubo O, Ikeda A, Miyajima E, Ishii M. Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder. Hypertension. 1996; 27(6): 1318-1324.PubMedCrossRefGoogle Scholar
  58. 58.
    Ferrie JE, Kivimäki M, Akbaraly TN, Singh-Manoux A, Miller MA, Gimeno D, et al. Associations between change in sleep duration and inflammation: Findings on C-reactive protein and interleukin 6 in the Whitehall II Study. Am J Epidemiol. 2013; 178(6):956-961Google Scholar
  59. 59.
    Prather AA, Epel ES, Cohen BE, Neylan TC, Whooley MA. Gender differences in the prospective associations of self-reported sleep quality with biomarkers of systemic inflammation and coagulation: Findings from the Heart and Soul Study. J Psychiatr Res. 2013; 47(9): 1228-1235.PubMedCrossRefGoogle Scholar
  60. 60.
    Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg. 2000; 69(4): 1198-1204.PubMedCrossRefGoogle Scholar
  61. 61.
    Hedner J, Caidahl K, Sjöland H, Karlsson T, Herlitz J. Sleep habits and their association with mortality during 5-year follow-up after coronary artery bypass surgery. Acta Cardiol. 2002; 57(5): 341-348.PubMedCrossRefGoogle Scholar
  62. 62.
    Fernandez-Mendoza J, Calhoun SL, Bixler EO, et al. Sleep misperception and chronic insomnia in the general population: Role of objective sleep duration and psychological profiles. Psychosom Med. 2011; 73(1): 88-97.PubMedCentralPubMedCrossRefGoogle Scholar
  63. 63.
    Lauderdale DS, Knutson KL, Yan LL, Liu K, Rathouz PJ. Self-reported and measured sleep duration: How similar are they? Epidemiology. 2008; 19(6): 838-845.PubMedCentralPubMedCrossRefGoogle Scholar
  64. 64.
    Silva GE, Goodwin JL, Sherrill DL, et al. Relationship between reported and measured sleep times: The Sleep Heart Health Study (SHHS). J Clin Sleep Med. 2007; 3(6): 622-630.PubMedCentralPubMedGoogle Scholar
  65. 65.
    Van Den Berg JF, Van Rooij FJA, Vos H, et al. Disagreement between subjective and actigraphic measures of sleep duration in a population-based study of elderly persons. J Sleep Res. 2008; 17(3): 295-302.CrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2013

Authors and Affiliations

  • Lydia Poole
    • 1
  • Tara Kidd
    • 1
  • Elizabeth Leigh
    • 1
  • Amy Ronaldson
    • 1
  • Marjan Jahangiri
    • 2
  • Andrew Steptoe
    • 1
  1. 1.Department of Epidemiology and Public HealthUniversity College LondonLondonUK
  2. 2.Department of Cardiac Surgery, St George’s HospitalUniversity of LondonLondonUK

Personalised recommendations