A systematic review of sleep patterns and factors that disturb sleep after heart surgery.

BACKGROUND Sleep is a vital and restorative human function. However, it has been reported that up to 50% of heart surgery patients experience sleep disturbance during hospitalization and after discharge. PURPOSE This study describes sleep patterns in adults over the recovery course after heart surgery and works to identify potential interventions. Researchers analyzed and synthesized studies of sleep patterns and sleep-related factors in heart surgery patients. METHODS Observational studies describing sleep through the course of recovery from heart surgery were searched from databases of PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Current Contents, and Chinese Electronic Periodicals Service from 1966 to 2011. Only studies that used polysomnography, actigraphy, or self-report sleep questionnaires to measure sleep were recruited in this review. Results of sleep patterns and sleep quality were pooled from homogeneity studies. RESULTS Eight studies that investigated sleep patterns in heart surgery patient and nine studies that examined factors associated with sleep disturbances in this patient group were analyzed and synthesized. Serious problems including low sleep efficiency and difficulty in maintaining sleep often happened during the first postoperative week. It took 2 months for sleep to recover to preoperational levels. Although sleep quality improved over time, sleep disturbances still persisted through 6 months of recovery. Physical factors, including pain, dyspnea, nocturia, and cardiac function, and environmental factors, including noise, light, and procedures on patients, were associated with sleep disturbances during hospitalization. Psychological factors, including anxiety and depression, affected sleep during the first -6 months after discharge. Individual factors of age and gender affected sleep through the entire recovery course. CONCLUSIONS/IMPLICATION FOR PRACTICE: Sleep disturbances persist over the course of recovery in heart surgery patients, and sleep disturbance is associated with individual, physiological, psychological, and environmental factors. Findings suggest that management of major symptoms and control of the patient's sleeping environment during hospitalization and at early recovery stage as well as mental healthcare after discharge may improve sleep quality and recovery in heart surgery patients.