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

ArticleinProgress in transplantation (Aliso Viejo, Calif.) 21(2):131-6 · June 2011with16 Reads
DOI: 10.7182/prtr.21.2.cp5874v2l28g62x6 · Source: PubMed
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.
  • [Show abstract] [Hide abstract] ABSTRACT: To identify and describe: (1) characteristics of sleep quality, daytime sleepiness, and quality of life (QOL) pre and post implantation of a left ventricular assist device (LVAD); (2) changes in sleep quality, daytime sleepiness, and QOL at baseline and 6 months post implant; and (3) relationships among the sleep quality, daytime sleepiness, and QOL variables. We employed an exploratory research design. Fifteen patients with continuous/non-pulsatile flow LVAD consented to partake in the study. However, only 12 patients completed the baseline and 6-month post-LVAD implant data. We used the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) to measure study variables. Data were analyzed using IBM SPSS 19.0 software. Patients reported worse sleep quality accompanied by daytime sleepiness particularly at baseline, and persisting up to 6 months post LVAD implant. A significant improvement in QOL was observed at 6 months post implant, but remained at poor levels. Correlations among sleep disturbance and daytime dysfunction components of PSQI and global daytime sleepiness (ESS) with QOL were strong (Pearson's correlations r >.60; p values < .05). We report the first empirical data describing the characteristics and correlations among sleep quality, daytime sleepiness, and QOL in patients with LVADs. Our findings offer beginning evidence about the sleep-QOL connection in this population which warrants attention in clinical practice and research. Further research is required to clearly elucidate these phenomena in patients with mechanical circulatory support and other implantable artificial organs.
    Full-text · Article · Jun 2012
  • [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.
    Article · Aug 2012
  • Article · Aug 2012
Show more