Sleep during and after cardiothoracic intensive care and psychological health during recovery

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The research in this thesis investigated sleep and recovery in coronary artery bypass graft (CABG) patients during and after Intensive Care Unit (ICU) treatment. Intensive care patients and former ICU patients experience sleep disruption and poor sleep quality. Psychological distress, including depression, anxiety, stress and symptoms of posttraumatic stress disorder (PTSD), and diminished health-related quality of life (HRQOL) are common among former ICU patients. Few previous studies employed longitudinal analysis to explore continuity of problems related to sleep disruption and poor sleep quality, and whether patients who experience sleep problem in ICU continue to have sleep problems during recovery. Few studies have compared sleep between on-pump and off-pump open-heart surgery patients. The main reason for adult ICU admission in Australia is CABG surgery. Therefore cardiothoracic ICU patients were the focus of this study. The broad aim was to determine any association between sleep disruption in the cardiothoracic ICU and during recovery, and patients’ psychological wellbeing and HRQOL during recovery. One-hundred and one ICU patients who had undergone CABG surgery completed self-report questionnaires on their sleep quality in ICU, on the ward, and at two and six months after discharge; prehospital sleep state was retrospectively reported while in ICU. Perception of the ICU experience was assessed at two months after discharge, and psychological health and HRQOL six months after discharge using validated instruments. Descriptive and multivariate statistical analyses revealed that patients had a mean age of 66.60±11.07 years, 78% were male and the median ICU stay was two days. In ICU, 76.0% of patients reported poor sleep quality, 71.9% in the ward, and 68.4% and 62.0% at two and six months after discharge; 11.9% of patients had poor sleep at all time points. Six months after hospital discharge there was a positive relationship between poor sleep quality and lower psychological wellbeing and lower HRQOL in bivariate analyses. In multivariate analysis, prehospitalisation insomnia (p=0.004), and mental (p≤0.0005) and physical (p≤0.0005) HRQOL were independently associated with sleep quality at six months after discharge, but not on-pump versus off-pump open heart surgical technique. In conclusion, it has been shown in this thesis that the quality of sleep of a substantial proportion of postoperative CABG patients is often poor in ICU, in hospital and up to six months after hospital discharge. This was associated with physical and mental aspects of HRQOL six months after discharge, but not with whether surgery was performed on or off cardiopulmonary bypass.
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