An Exploratory Study to Assess the Contributing Factors Affecting Sleep Pattern of Patients Following Open Heart Surgery in Selected Hospitals, Mangalore

 

Tincymol George¹, Dr. Larissa Martha Sams²

¹M.Sc Nursing Student, Med. Surg. Department, Laxmi Memorial College of Nursing, Balmatta, Mangalore, Karnataka. India.

²Principal and HOD, Laxmi Memorial College of Nursing, Balmatta, Mangalore, Karnataka. India.

 

ABSTRACT:

Sleep is necessary and an essential part of the 24-hour cycle, and the quality and quantity of sleep are reflected by the individual’s daytime function. It is a natural state of bodily rest observed in humans. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and it is more easily reversible than hibernation or coma. When there is reduced sleep, we become irritable, tired, and aggressive, more likely to have confused reaction. Sleep disturbance is common problem among hospitalized patients especially in critical care units. This becomes worse during the recovery period of surgical cases especially following open heart surgery cases due to several factors.

 

 

INTRODUCTION:

Heart disease is one of the most common non communicable diseases in India¹. Approximately 2.4 million people needed heart surgery every year, although due to lack of affordable treatment, only 60,000 surgeries were performed. The prevalence of the disease had significant implications on its Workforce it was estimated that 28% of the 5 million Indians who died of cardiovascular disease every year were under 65 years and almost 25% of heart attacks occurred among the under-40 population². Cardiac surgery is one of the several treatment modalities of heart diseases. Bangaloreis the top destination of India for cardiac surgery. At Narayana Hrudyalya, Bangalore, 15 cardiac surgeries are done per day³.

 

During the recovery time after cardiac surgery, seventy percent of patient’s complaint of sleeps problems. Sleep is a basic human need. It is a state of rest accompanied by altered consciousness.

 

Proper sleep is an important to health as good nutrition. Sleep is required for many reasons: to rest mind and body, to prevent fatigue, to conserve energy, to cope with daily stress. It promotes proper day time functioning. Many post-operative cardiac patients experiences poor, fragmented sleep due to several reasons such as combination of the effects of anaesthesia, or it could be because of certain environmental or non – environmental factors such as pain or discomfort in the area of the incisions, increased ICU noise, frequent interruptions for diagnostic tests, routine patient care, and administration of certain drugs. Nursing professionals can no longer ignore sleep disturbance in post-operative cardiac surgery patients. Inadequate amount of sleep decreases the concentration, ability to make judgment, increases irritability, delay in recovery process and lead to prolonged hospitalization also.⁴

 

REVIEW OF THE LITERATURE:

A systematic study was conducted on sleep pattern and factors that disturb sleep after open heart surgery in University of Oklahoma Health Sciences Centre. The purpose of the study was to describe quality of sleep pattern and sleep disturbances among adult patients following open heart surgery. Eight studies that investigated sleep patterns in the heart surgery and nine studies that examined factors associated with sleep disturbances. A self -report sleep questionnaires were used to measure sleep quality among patients. Results showed that serious problems including low sleep efficiency and difficulty in maintaining sleep often happened during the first post –operative week. It took two months for sleep to recover to preoperational levels. Physical factors such as pain, dyspnoea, nocturia and environmental factors including noise, light, and procedures on patients were considered as important factors for sleep disturbances. The study findings concluded that sleep disturbances persist over the course of recovery in heart surgery patients, and sleep disturbances is associated with individual, physiological, psychological and environmental factors.⁵

 

An exploratory study was conducted on sleep disturbances after CABG Surgery. The purpose of this study was to describe the nature and frequency of sleep pattern disturbances in patients with post coronary artery bypass (CABG) surgery. An exploratory design using telephone interviews at one week, one month, three months and six months was used to describe the incidence and nature of sleep disturbances in post CABG surgery. Forty- nine patients completed all four measurement times. More than half of the patients reported sleep disturbances at each measurement time. They finally concluded that Sleep disturbances during the first month post CABG were reported to be the result of incision pain, difficulty finding a comfortable position and nocturia. Although less frequent over time, these problems persisted for six months.⁶

 

OBJECTIVES:

·        To determine the quality of sleep among patients following open heart surgery.

·        To find out the contributing factors affecting sleep pattern among patients following open heart surgery

 

METHODOLOGY:

Setting: The study was conducted in selected hospitals of Mangalore.

 

Population: Patients following open heart surgery

 

Sample size: 25

 

Sampling technique: convenient sampling technique was used to select samples.

 

Research Design: Exploratory descriptive research design

 

Tools:

·        Demographic factors.

·        Pittsburg Sleep Quality Index (PSQI) to assess the sleep quality of hospitalized patients.

·        Factors Affecting Sleep Quality Questionnaire (FASQ) to assess the contributing factors that affecting sleep pattern of patients.

 

Data collection method:

·        Prior to data collection, permission was obtained from the concerned authority for conducting the study.

·        Ethical clearance was obtained from the AJ ethical committee

·        Subjects were selected according to the selection criteria of the sample.

·        Informed consent was obtained from the sample’s parents.

·        Scale and questionnaire were administered to 25 patients following open heart surgery in selected hospitals, Mangalore.

 

Result of the study:

1.      Highest percentage of subjects 10 (40%) were within the age group of 51 – 60 years. Majority 18 (72%) of subjects were males. Majority 19 (76%) of subjects were married. Highest percentage of subjects 10 (40 %) had the habits of smoking. Highest percentage of subjects 10 (40%) had the history of hypertension. Highest percentage of subjects 13 (52%) were on antihypertensive medications. Majority 15 (60%) of subjects had the history of past cardiac surgeries.

2.      Highest percentage (44%) of subjects had worst quality of sleep, 36 % had average quality and only 20% had good quality of sleep following open heart surgery.

3.      The environmental factors like excessive lighting, increased noise in the ward, uncomfortable bed, room temperature, devices have got highest percentage score i.e 80.00%, and the sleep related factors that is waking up earlier, interrupted sleep, sleeping less than sleep, waking up suddenly got least percentage i.e30%.

 

Figure 1: Description of quality of sleep scores of patients following open heart surgery.

Pittsburg Sleep Quality Index (PSQI) Scale was used to determine the quality of sleep scores of patients following open heart surgery.

 

Cone diagram showing distribution of subjects according to their quality of sleep score.

Table 1:Frequency and Percentage distribution of factors affecting quality of sleep among open heart surgery patients  = 25

Factors	Present (1)		Absent (0)
	Frequency (f)	Percentage (%)	Frequency (f)	Percentage (%)
1.       Factors related to sleep characteristics. ·        Sleeping Earlier ·        Waking up earlier ·        Interrupted sleep ·        Sleeping less than sleep ·        Waking up suddenly	13 10 12 10 0	52 40 48 40 0	12 15 13 15 25	48 60 52 60 100
2.       Environmental Factors ·        Excessive Lighting ·        Increased noise in the ward ·        Uncomfortable bed ·        Room Temperature ·        Devices Alarm	25 25 10 20 23	100 100 40 80 92	0 0 15 5 2	0 0 60 20 8
3.       Non-environmental Factors ·        Fear and Concern ·        Feeling Pain	10 6	40 24	15 19	60 76
4.       Factors related to patient caring ·        Care provided to the client ·        Care provided to other patients ·        Nursing routine	15 2 12	60 8 48	10 23 13	40 92 52

 

Table 2: Mean, SD and Mean Percentage of scores on factors affecting quality of sleep N = 25

	Factors	Max. score	Mean	SD	Mean %
1. 2. 3. 4.	Factors related to sleep characteristics Environmental  Factors Non-environmental  Factors Factors related to patient caring	5 6 2 3	0.90 0.80 3.52 2.9	2.01 0.44 1.02 0.92	30.00 80.00 58.66 48.33

Figure 2: Pyramid diagram showing factors affecting the quality of sleep.

 

Table 3: Correlation between quality of sleep and factors affecting quality of sleep among patients following open heart surgery N=25

Sl. No	Factors	r	df	Table Value
1.	Factors related to sleep characteristics	-0.87	24	0.388
2.	Environmental factors	-0.9	24	0.388
3.	Non Environmental factors	-0.45	24	0.388
4.	Factors related to patient caring	-0.48	24	0.388

(r=0.388, p<0.05)

 

Table 4: Regression analysis showing relationship between quality of sleep and factors affecting quality of sleep among open heart surgery patients. N=25

                                                                                                                             

INTERPRETATION AND CONCLUSION:

Findings of the study showed that there are certain factors in the hospital that can affect the quality of sleep among patients following open heart surgery which indicated the need for improving measures in patients sleep pattern.

 

BIBLIOGRAPHY:

1.       Chinthamani, Lewis. Medical Surgical Nursing. New Delhi: Mosby Elsevier Publications; 2011.

2.       World Health Organization [online].2012 February 05 [cited 2012 July 02]; Available from:  URL: http://www.who.int/ cadrdiovascular disease

3.       Tarunkhanna,  Kasthuriranga V, Merlina M. Narayana Hrudayalaya Heart Hospital, Cardiac care for the poor, Harward Buisines School, 2005.

4.       Kozier B, Erb B, Berman A, Synder SJ. Fundamentals of nursing – concepts, process , and practice.9^th ed. Delhi: Saurabh Printers Pvt. Ltd; 2011.

5.       Schaffer KM., Swavely D., Rothenberger C., Hess S, Williston D. Sleep disturbances  Post CABG   Surgery 1996;11(1):5-14.

6.       Panda S, Manjari NR. Sleep factor pattern and factors disturb sleep after surgery. Journal of Association of Physicians of India 2005; 53(2):110-5.

 

 

Received on 07.06.2014                Modified on 12.07.2014

Accepted on 28.07.2014                © A&V Publication all right reserved