Article

Sleep and daytime sleepiness of patients with left ventricular assist devices: a longitudinal pilot study

Wayne State University, 5557 Cass Avenue, Cohn 352, Detroit, MI 48202, USA.
Progress in transplantation (Aliso Viejo, Calif.) (Impact Factor: 0.69). 06/2011; 21(2):131-6. DOI: 10.7182/prtr.21.2.cp5874v2l28g62x6
Source: PubMed

ABSTRACT No empirical longitudinal data on sleep and daytime sleepiness patterns in patients with an implantable left ventricular assist device (LVAD) exist.
(1) To describe the sleep patterns (sleep onset latency, sleep efficiency, sleep fragmentation index, total sleep time, and wake after sleep onset), sleep quality, and daytime sleepiness variables and (2) to determine the change in the pattern of these variables before and up to 6 months after LVAD implantation.
A longitudinal descriptive repeated-measures design was used. Patients wore wrist actigraphs (AW64 Actiwatch), which objectively measured sleep, for 3 consecutive days and nights before LVAD implant and at the first and second week and first, third, and sixth month after implantation. During these periods, patients also completed questionnaires on sleep quality and daytime sleepiness. Patients-Twelve of 15 patients completed the 6-month data. Data were analyzed by using descriptive statistics and repeated-measures analysis of variance.
We found long sleep onset latencies and low sleep efficiency across time periods. High sleep fragmentation index was noted at baseline and 1 week after LVAD. Short total sleep times, long wake-after-sleep-onset durations, and poor sleep quality were evident at baseline and persisted up to 6 months after LVAD implantation. Low alertness level, a manifestation of sleepiness, was common during late morning to early evening hours. However, only sleep efficiency and wake after sleep onset showed significant changes in pattern (P < .05).
Sleep disturbance and daytime sleepiness may be prevalent before and up to 6 months after LVAD implantation, warranting further investigation.

1 Follower
 · 
141 Views
 · 
0 Downloads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Psychosocial outcomes and quality-of-life (QOL) are important indicators of the success of heart transplantation and mechanical circulatory support (MCS). They warrant further research attention given the increasing frequency of these interventions and the diverse uses of MCS as destination therapy and bridge to transplant. The literature has continued to identify correlates and predictors of psychosocial outcomes in five domains: physical functioning, psychological, behavioral, social functioning and global QOL. These issues in MCS patients, in particular, are receiving increased attention. Recent work also highlights the potential for psychosocial outcomes to predict transplant-related and MCS-related clinical outcomes, and also emphasizes issues involved in heart transplantation for older adults, heart transplantation for intellectually disabled individuals, and managing end-of-life planning in patients with MCS. This field continues to be dominated by descriptive studies. Although recent work has provided a more complete picture of correlates of psychosocial outcomes, there is a need for intervention research to examine strategies to optimize these outcomes in both heart transplant and MCS populations. Clinicians should continue to monitor and address psychosocial issues with their patients in order to achieve posttransplant and postimplantation success that prolongs both quantity and QOL.
    Current opinion in organ transplantation 08/2012; 17(5):558-63. DOI:10.1097/MOT.0b013e3283564f45 · 2.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients undergoing surgery have severe sleep and sleep-wake rhythm disturbances resulting in increased morbidity. Actigraphy is a tool that can be used to quantify these disturbances. The aim of this manuscript was to present the literature where actigraphy has been used to measure sleep and sleep-wake rhythms in relation to surgery. A systematic review was performed in 3 databases (Medline, Embase, and Psycinfo), including all literature until July 2012. Thirty-two studies were included in the review. Actigraphy could demonstrate that total sleep time and sleep efficiency was reduced after surgery and number of awakenings was increased in patients undergoing major surgery. Disturbances were less severe in patients undergoing minor surgery. Actigraphy could be used to differentiate between delirious and non-delirious patients after major surgery. Actigraphy measurements could determine a differential effect of surgery based on the patient's age. The effect of pharmacological interventions (chronobiotics and hypnotics) in surgical patients could also be demonstrated by actigraphy. Actigraphy can be used to measure sleep and sleep-wake rhythms in patients undergoing surgery. CITATION: Madsen MT; Rosenberg J; Gögenur I. Actigraphy for measurement of sleep and sleep-wake rhythms in relation to surgery. J Clin Sleep Med 2013;9(4):387-394.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2013; 9(4):387-94. DOI:10.5664/jcsm.2598 · 2.83 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This article reviews some of the complex ethical issues that accompany the diffusion of ventricular assist devices (VADs) for heart failure patients, with a particular emphasis on issues unique to older adults. In doing so, the ethical issues are centered on three decision points: (a) patient selection; (b) informed consent (i.e., initiation of the device); and (c) end of life (i.e., deactivation of the device.) It is contended that, with the technological improvements in heart failure treatments and new indications, the decision making process for VAD placement and deactivation has become more clinically and ethically challenging, particularly for older adults. Areas for potential future research are identified.
    Aging and Disease 04/2013; 4(2):100-12.
Show more