Sleep and Nighttime Care in Adult Cardiac Surgery Aaron Zalewski, Hillman Scholar & Jesus M. Casida, PhD, RN, APN-C, CCRN-CSC

University of Michigan School of Nursing, Ann Arbor, MI

Background and Significance

Specific Aims: 1. Describe subjects’ perceptions of nighttime sleep and daytime

function; and identify changes in nighttime sleep and daytime

function pre and post surgery.

2. Describe the relationship between nighttime sleep and daytime

function variables.

3. Describe nighttime routine care implemented during the

immediate post surgery period.

Conclusions

Patients’ perceived their nighttime sleep as “ineffective” throughout the

immediate post-operative period. Consequently, they required an

increased amount of daytime sleep (i.e., naps) to compensate for it.

Further research, involving a large and diverse sample size, is needed

to fully understand this phenomenon and examine to what extent

nighttime care routines or care processes affect patient sleep and

subsequent outcomes.

Nurses should lead the efforts in advancing sleep science in cardiac

surgery and are well positioned to transform care delivery processes at

night to promote patients’ sleep, health, and well-being.

Disrupted sleep is a common complaint among hospitalized patients.

However, in cardiac surgery, little is known about this problem.

Additionally, little is known about routine care delivered at night, which

purportedly disrupts patients’ sleep.

Exploratory, repeated measures research design was employed

using data collected from 38 subjects, aged 37 to 90 years, who

participated in a clinical trial implemented in cardiothoracic ICU and

step-down units of an urban hospital in Michigan.

All subjects underwent first time elective cardiac surgery using

cardiopulmonary bypass. Details of subjects’ demographics, clinical

characteristics, and study eligibility criteria are found in the handouts

below.

Variables & Measures: Nighttime sleep (sleep effectiveness) and daytime function (daytime

sleep supplementation) were measured with 6-item visual analog

sleep scales (100 mm horizontal lines):

Nighttime routine care delivered during sleep hours (after midnight

and until 6AM) was recorded on a checklist by the bedside RN.

Figure 3 summarizes the “overall” NSE and DSS among the study

subjects. NSE was negatively correlated with DSS (r=-0.320, p=0.05).

Methods

Data Collection & Analysis: Pre-op data were obtained within 1 month prior to surgery.

Post-op data were obtained during post-op nights (PON)/ post-op

days (POD) 1 through 5.

Data were analyzed using descriptive and inferential statistics.

Results

Figure 2 summarizes the perceived DSS among the study subjects.

Post-op DSS component scores were higher than pre-op. Although

the changes in scores of each component (e.g., WAFA) were not

significant, the increase in the overall DSS scores from pre-op to post-

op were significant (F = 9.33, df = 5, η²p =0.66, p <0.001).

Figure 1 summarizes the perceived NSE among the study subjects.

SQ and TST scores were lower on PON 3 to 4 and appeared to

return to pre-op on PON 5. However, these changes and variability in

scores were not significant (F = 4.65, df = 5, η²p =0.80, p >0.05).

Figure 1:

Figure 2:

Figure 3:

The table below summarizes the post-op nighttime routine care that

purportedly disrupts the subjects’ sleep.