Three Enemies of Circadian Rhythm: Anxiety, Sleeplessness and Pain in Patients Following Open-Heart Surgery

Year 2019, Volume: 9 Issue: 3, 246 - 252, 30.09.2019

Eda Ayten Kankaya Ozlem Bilik

https://doi.org/10.33808/clinexphealthsci.599805

Cited By: 2

Abstract

Objective: This study aimed to determine the
relationship between preoperative anxiety and postoperative pain and
perioperative sleep quality in open-heart surgery patients.

Methods: It was a cross-sectional study. The research sample included 126 patients
who underwent open-heart
surgery for the
first time and remained in intensive care for a maximum period of 48 hours. All patients’ procedures were
performed with cardiopulmonary bypass and sternotomy.
Data were collected using a Patient Identification Form, developed by the researcher and
used to determine patients’ characteristics; the Anxiety Specific to Surgery Questionnaire
(ASSQ), used to determine patients’ anxiety level; the Pittsburgh
Sleep Quality Index (PSQI), used to measure perioperative sleep quality,
and the Numeric
Pain Scale (NPS), used to determine postoperative pain levels.

Results: Open-heart
surgery
patients experienced moderate levels of anxiety (27.28±8.48), moderate
postoperative pain (4.30±2.29) and poor sleep quality (10.27±4.23) perioperative period. In this paper, a significant,
weak, and positive correlation between ASSQ score and postoperative NPS score
(r=0.318, p<0.05) was found; no correlation between the ASSQ score and
perioperative PSQI score was found. It was determined that 90.48% (n = 114) of
patients who underwent open heart surgery had poor sleep quality and there was
no relation between preoperative anxiety and postoperative sleep quality.

Conclusion: The authors concluded that preoperative
anxiety impacts postoperative pain but has no effect on sleep quality for open-heart
surgery patients
in Turkish people.

Keywords

Heart surgery, nursing, pain, sleep, anxiety

References

• • Agargun, Y. M., Kara, H., & Anlar, Ö. (1996). The reliability and validity of Turkish version of Pittsburgh Sleep Quality Index. Turkish Psycology Journal., 7, 107-115.
• • Akinci, B., Yeldan, I., Bayramoglu, Z., & Akpinar, T. B. (2015). The effects of posture and relaxation training on sleep, dyspnoea, pain and, quality of life in the short-term after cardiac surgery: A pilot study. European Journal of Preventive Cardiology, 22(1 SUPPL. 1), 171–172. http://doi.org/http://dx.doi.org/10.1177/2047487315586749.
• • Akıncı, E., & Orhan, F. Ö. (2016). Circadian Rhythm Sleep Disorders. Current Approaches in Psychiatry. 2016;8(2):178. http://doi.org/10.18863/pgy.81775.
• • Arita, H., Takeno, Y., & Fujimoto, E. (2014). Sleep Disturbance in Elderly Patients after Cardiac Surgery during their Stay in Intensive Care Unit and Surgical Ward. Journal of Nursing & Care, 3(1), 1–6. http://doi.org/10.4172/2167-1168.1000137.
• • Bjørnnes, A. K., Rustoen, T., Lie, I., Watt-Watson, J., & Leegaard, M. (2014). Pain characteristics and analgesic intake before and following cardiac surgery. European Journal of Cardiovascular Nursing, (1). http://doi.org/10.1177/1474515114550441.
• • Buysse, D. J., Reynolds, C. F. 3Rd, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research. Psychiatry Res. http://doi.org/10.1016/0165-1781(89)90047-4.
• • Chan, M. C., Spieth, P. M., Quinn, K., Parotto, M., Zhang, H., & Slutsky, A. S. (January 01, 2012). Circadian rhythms: From basic mechanisms to the intensive care unit. Critical Care Medicine, 40, 1, 246-253. http://doi.org/10.1097/CCM.0b013e31822f0abe.Circadian.
• • Coles, M. E., Schubert, J. R., Nota, J. A. (2015) Sleep, Circadian Rhythms, and Anxious Traits. Current Psychiatry Reports., 17(9), 73. http://doi.org/10.1007/s11920-015-0613-x.
• • Cserep, Z., Losoncz, E., Balog, P., Szili-Torok, T., Husz, A., Juhasz, B., et al. (2012). The impact of preoperative anxiety and education level on long-term mortality after cardiac surgery. Journal of Cardiothoracic Surgery, 7, 86. https://doi.org/10.1186/1749-8090-7-86 .
• • Douki, Z. E., Vaezzadeh, N., & Shahmohammadi, S. (2011). Anxiety Before and after Coronary Artery Bypass Grafting Surgery : Relationship to QOL. Middle-East Journal of Scientific Research, 7(1), 103–108.
• • Elliott, R., Rai, T., & McKinley, S. (2014). Factors affecting sleep in the critically ill: An observational study. Journal of Critical Care, 29(5), 859–863. http://doi.org/10.1016/j.jcrc.2014.05.015.
• • Engwall, M., Fridh, I., Johansson, L., Bergbom, I., & Lindahl, B. (2015). Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit. Intensive and Critical Care Nursing, 31(6), 325–335. http://doi.org/10.1016/j.iccn.2015.07.001.
• • Eti Aslan, F., Öztürk, Z. (2014). Nature and control of pain. (23th ed). Ankara: Akademisyen Bookstore.
• • Feuchtinger, J., Burbaum, C., Heilmann, C., Imbery, C., Siepe, M., Stotz, U., et al. (2013). Anxiety and fear in patients with short waiting times before coronary artery bypass surgery - a qualitative study. Journal of Clinical Nursing, 23(13–14), 1900–1907. http://doi.org/10.1111/jocn.12467.
• • Fındık, Ü. Y, &Yıldızeli Topcu, S. (2012). Effect of the way of surgery on preoperative anxiety. Hacettepe University Faculty of Health Sciences Nursing Journal., 22-23 https://doi.org/10.1016/j.pmn.2010.07.006. • Fitzsimons, D., Parahoo, K., Richardson, S. G., & Stringer, M. (2003). Patient anxiety while on a waiting list for coronary artery bypass surgery: a qualitative and quantitative analysis. Heart & Lung : The Journal of Critical Care, 32(1), 23–31. http://doi.org/10.1067/mhl.2003.3. • Guo, P. (2014). Preoperative education interventions to reduce anxiety and improve recovery among cardiac surgery patients: a review of randomised controlled trials. Journal of Clinical Nursing, 24, 34–46 https://doi.org/10.1111/jocn.12618.
• • Guo, P., East, L., & Arthur, A. (2012). A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: A randomized controlled trial. International Journal of Nursing Studies, 49(2), 129–137. http://doi.org/10.1016/j.ijnurstu.2011.08.008.
• • Hedges, C., & Redeker, N. S. (2008) Comparison of sleep and mood in patients after on-pump and off-pump coronary artery bypass surgery. American Journal of Critical Care.,17, 133-141. • Hernández-Palazón, J., Fuentes-García, D., Falcón-Araña, L., Roca-Calvo, M. J., Burguillos-López, S., Doménech-Asensi, P., & Jara-Rubio, R. (2017). Assessment of Preoperative Anxiety in Cardiac Surgery Patients Lacking a History of Anxiety: Contributing Factors and Postoperative Morbidity. Journal of Cardiothoracic and Vascular Anesthesia, 4(44) http://dx.doi.org/10.1053/j.jvca.2017.04.044.
• • Hoyer, J., Eifert, G. H., Einsle, F., Zimmermann, K., Krauss, S., Knaut, M., et al. (2008). Heart-focused anxiety before and after cardiac surgery. Journal of Psychosomatic Research, 64(3), 291–297. http://doi.org/10.1016/j.jpsychores.2007.09.009.
• • Huang, A. P. S., & Sakata, R. K. (2016). Pain after sternotomy – review. Brazilian Journal of Anesthesiology (English Edition), 66(4), 395–401. http://doi.org/10.1016/j.bjane.2014.09.013.
• • Kamalipour, H., Vafaei, A., Parviz Kazemi, A., & Khademi, S. (2014). Comparing the Prevalence of Chronic Pain After Sternotomy in Patients Undergoing Coronary Artery Bypass Grafting Using The Internal Mammary Artery and Other Open Heart Surgeries. Anesthesiology and Pain Medicine, 4(3), e17969. http://doi.org/10.5812/aapm.17969.
• • Kamdar, B. B., Needham, D. M., & Collop, N. A. (2012). Sleep Deprivation in Critical Illness: Its Role in Physical and Psychological Recovery. Journal of Intensive Care Medicine, 27(2), 97–111. http://doi.org/10.1177/0885066610394322. • Karanci, A. N., & Dirik, G. (January 01, 2003). Predictors of pre- and postoperative anxiety in emergency surgery patients. Journal of Psychosomatic Research, 55, 4, 363-369. https://doi.org/10.1016/S0022-3999(02)00631-1.
• • Khalkhali, H., Tanha, Z. E., Feizi, A., & Ardabili, S. S. (2014). Effect of applying cold gel pack on the pain associated with deep breathing and coughing after open heart surgery. Iranian Journal of Nursing and Midwifery Research, 19, 6, 545-9. • Khan, R. S., Skapinakis, P., Ahmed, K., Stefanou, D. C., Ashrafian, H., Darzi, A., & Athanasiou, T. (2012). The association between preoperative pain catastrophizing and postoperative pain intensity in cardiac surgery patients. Pain Medicine, 13(6), 820–7. http://doi.org/10.1111/j.1526-4637.2012.01386.x.
• • Kocabasoglu N. (2008). An overview of anxiety disorders. Symposium Series of Frequent psychiatric diseases in Turkey, 62, 175-184.
• • Koivula, M., Tarkka, M., Tarkka, M., Laippala, P., & Paunonen-ilmonen, M. (2002) Fear and anxiety in patients at different time-points in the coronary artery bypass process. International Journal of Nursing Studies. , 39, 811–822 http://dx.doi.org/10.1016/S0020-7489(02)00022-6.
• • Le Grande. M. R., Jackson, A. C., Murphy, B. M., & Thomason, N. (2016). Relationship between sleep disturbance, depression and anxiety in the 12 months following a cardiac event. Psychology, Health and Medicine, 21, 1, 52-59., http://dx.doi.org/10.1080/13548506.2015.1040032.
• • Leegaard, M., Nåden, D., & Fagermoen, M. S. (2008). Postoperative pain and self-management: Women’s experiences after cardiac surgery. Journal of Advanced Nursing, 63(5), 476–485. http://doi.org/10.1111/j.1365-2648.2008.04727.x.
• • Liao, W. C., Huang, C. Y., Huang, T. Y., & Hwang, S. L. (2011). A Systematic Review of Sleep Patterns and Factors That Disturb Sleep After Heart Surgery. Journal of Nursing Research, 19(4), 275–288. http://doi.org/10.1097/JNR.0b013e318236cf68.
• • Little, A., Ethier, C., Ayas, N., Thanachayanont, T., Jiang, D., & Mehta, S. (2012). A patient survey of sleep quality in the Intensive Care Unit. Minerva Anestesiologica, 78, 4, 406-414.
• • Mathai, A. T., & Sams, L. M. (2015). Assessment Of Quality Of Pain And Contributing Factors Affecting Level Of Pain Among Patients Who Had Undergone Cardiac Surgery In Selected Hospitals , Mangalore. Asian Pacific Journal of Nursing, 2(1), 8–11.
• • Matthews E. E. (2012) Sleep Disturbances and Fatigue in Critically Ill Patients. AACN Adv Critical Care. 22(3), 204–224. http://doi.org/10.1097/NCI.0b013e31822052cb.Sleep.
• • Mello, L. C. De, Rosatti, S. F. C., & Hortense, P. (2014). Assessment of pain during rest and during activities in the postoperative period of cardiac surgery. Revista Latino-Americana de Enfermagem, 22(1), 136–143. http://doi.org/10.1590/0104-1169.3115.2391.
• • Mirbagher Ajorpaz, N., Mohammadi, A., Najaran, H., & Khazaei, S. (2014). Effect of Music on Postoperative Pain in Patients Under Open Heart Surgery. Nursing and Midwifery Studies, 3(3), e20213.
• • Oderda, G. (2012) Challenges in the Management of Acute Postsurgical Pain. Pharmacotherapy. , 32(9), 6-11 https://doi.org/10.1002/j.1875-9114.2012.01177.x.
• • Oz F. (2014). Anxiety problems. In: Gorman LM, Sultan DF. Öz F, Demiralp M, editors. Psychosocial Nursing. (3th ed). Ankara: Akademisyen Bookstore.
• • Ozkaya, B. O., Yuce, Z., Gonenc, M., Gul, A., & Alis, H. (2013). Factors affecting the sleep pattern of the patients in the early postoperative period. Medical Journal of Bakirkoy, 9(3), 121–125. http://doi.org/10.5350/BTDMJB201309305.
• • Ozpelit, M. E., Ozpelit, E., Dogan, N. B., Pekel, N., Ozyurtlu, F., Yilmaz, A.,et al. (2015). Impact of anxiety level on circadian rhythm of blood pressure in hypertensive patients. International Journal of Clinical and Experimental Medicine, 8(9), 16252–16258.
• • Ozturk, O. M., Ulusahin, A. (2015). Mental health and disorders. (13th ed). Ankara:Tuna Printing.
• • Parizad, R., Abdolahzadeh, F., & Mousavi-Shabestari, M. (2014). Pain after Cardiac Surgery : A Review of the Assessment and Management. Crescent Journal of Medical and Biological Sciences, 1(4), 113–117.
• • Parvan, K., Zamanzadeh, V., Dizaji, S. L., Shabestari, M. M., & Safaie, N. (2013). Patient’s perception of stressors associated with coronary artery bypass surgery. Journal of Cardiovascular and Thoracic Research, 5(3), 113–117. http://doi.org/10.5681/jcvtr.2013.024.
• • Pröpper, J., Valen, R. Van, Domburg, R. T. Van, Brunott, M., & Bogers, A. J. J. C. (2015). Quality of Sleep at the Ward after Cardiothoracic Surgery. Open Journal of Nursing, 5, 529–537 http://dx.doi.org/10.4236/ojn.2015.56056. • Rosiek, A., Kornatowski, T., Rosiek-kryszewska, A., Leksowski, A., & Leksowski, K. (2016). Evaluation of Stress Intensity and Anxiety Level in Preoperative Period of Cardiac Patients. BioMed Research International, 2016, 1–8. http://doi.org/10.1155/2016/1248396.
• • Sidar, A., Dedeli, O., & Iskesen, A. I. (2014). The Relationship Between Anxiety, Pain Distress and Pain Severity Before and After Open Heart Surgery in Patients. Turkish Journal of Medical and Surgical Intensive Care, 4(1), 1–8. http://doi.org/10.5152/dcbybd.2013.02.
• • Takagi, H. , Ando, T., Umemoto, T. (2017) Perioperative depression or anxiety and postoperative mortality in cardiac surgery: a systematic review and meta‑analysis. Heart Vessels, 32(12), 1458-1468 doi:10.1007/s00380-017-1022-3.
• • Tully, P. J., & Baker, R. A. (2012). Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review. Journal of Geriatric Cardiology, 9(2), 197–208. http://doi.org/10.3724/SP.J.1263.2011.12221.
• • Yang, P. L., Huang, G. S., Tsai, C. S., & Lou, M. F. (2015). Sleep Quality and Emotional Correlates in Taiwanese Coronary Artery Bypass Graft Patients 1 Week and 1 Month after Hospital Discharge: A Repeated Descriptive Correlational Study. Plos One, 10(8), e0136431. http://doi.org/10.1371/journal.pone.0136431.
• • Yilmaz, M., Sezer, H., Gurler, H., & Bekar, M. (2011). Predictors of preoperative anxiety in surgical inpatients. Journal of Clinical Nursing, 21, 956–964. http://doi.org/10.1111/j.1365-2702.2011.03799.x.
• • Ziehm, S., Rosendahl, J., Barth, J., Strauss, B., Mehnert, A., & Koranyi, S. (2017). Psychological interventions for acute pain after open heart surgery. Cochrane Database of Systematic Reviews, 2017, 7. Art. No.: CD009984. Doi: 10.1002/14651858.CD009984.pub3.