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

<div><p>Background</p><p>Poor sleep quality is a common health problem for coronary artery bypass graft patients, however few studies have evaluated sleep quality during the period immediately following hospital discharge.</p><p>Purpose</p><p>The aim of this study was to investigate changes in sleep quality and emotional correlates in coronary artery bypass graft patients in Taiwan at 1 week and 1 month after hospital discharge.</p><p>Methods</p><p>We used a descriptive correlational design for this study. One week after discharge, 87 patients who had undergone coronary artery bypass surgery completed two structured questionnaires: the Pittsburgh Sleep Quality Index and the Hospital Anxiety and Depression Scale. Three weeks later (1 month after discharge) the patients completed the surveys again. Pearson correlations, t-tests, ANOVA and linear multiple regression analysis were used to analyze the data.</p><p>Results</p><p>A majority of the participants had poor sleep quality at 1 week (82.8%) and 1 month (66.7%) post-hospitalization, based on the global score of the Pittsburgh Sleep Quality Index. Despite poor sleep quality at both time-points the sleep quality at 1 month was significantly better than at 1-week post hospitalization. Poorer sleep quality correlated with older age, poorer heart function, anxiety and depression. The majority of participants had normal levels of anxiety at 1 week (69.0%) and 1 month (88.5%) as measured by the Hospital Anxiety and Depression Scale. However, some level of depression was seen at 1 week (78.1%) and 1 month (59.7%). Depression was a significant predictor of sleep quality at 1 week; at 1 month after hospital discharge both anxiety and depression were significant predictors of sleep quality.</p><p>Conclusion</p><p>Sleep quality, anxiety and depression all significantly improved 1 month after hospital discharge. However, more than half of the participants continued to have poor sleep quality and some level of depression. Health care personnel should be encouraged to assess sleep and emotional status in patients after coronary artery bypass surgery and offer them appropriate management strategies to improve sleep and reduce anxiety and depression.</p></div

Age-adjusted Spearman partial correlation coefficients between Gas6 levels and biochemical variables in CABG and control groups.

*<p>Corrected for age. <b>^§</b>The logarithms of these variables were used for the analysis. CABG, coronary artery bypass grafting; HbA1c, Hemoglobin A1c; AST, aspartate aminotransferase; ALT, alanine aminotransferase; BUN, blood urea nitrogen; HDL, high density lipoprotein; LDL, low density lipoprotein; ICAM-1, intercellular adhesion molecule 1; VCAM-1, vascular cell adhesion molecule 1; sAxl, soluble Axl; EuroSCORE, European system for cardiac operative risk evaluation. Boldface indicates statistical significance.</p

HADS scores: 1 week and 1 month post-hospitalization and the change in score at 1 month (<i>n</i> = 87).

<p>SD: standard deviation; HADS: Hospital Anxiety and Depression Scale;</p><p>^a = paired t-test.</p><p>HADS scores: 1 week and 1 month post-hospitalization and the change in score at 1 month (<i>n</i> = 87).</p

Plasma growth arrest-specific protein 6 (Gas6) and soluble Axl (sAxl) levels in control subjects (Control) and patients undergoing coronary artery bypass grafting (CABG).

<p>The lines represent the mean values in each group. The CABG group had significantly lower plasma Gas6 and sAxl levels than the control subject group (<i>P</i><0.0001 and <i>P</i><0.001, respectively).</p

Participant demographics (<i>n</i> = 87).

<p>*New York Heart Association (NYHA) Functional Classification.</p><p>Participant demographics (<i>n</i> = 87).</p

Correlations between plasma sAxl and growth arrest-specific protein 6 (Gas6) levels and between Axl and Gas6 expression in the aorta.

<p>The positive correlations between plasma sAxl and Gas6 levels were significant in both groups (A, B). The expression of Gas6 was significantly and positively correlated with Axl protein expression in the aorta (<i>P</i> = 0.0002).</p

Anthropometric and biochemical variables among CABG patients and matched control subjects.

*<p>assessed by paired <i>t</i>-test, data shown as mean ± standard error (<i>P</i><0.05).</p>§<p>The logarithms of these variables were used for the analysis.</p><p>CABG, coronary artery bypass grafting; HbA1c, Hemoglobin A1c; AST, aspartate aminotransferase; ALT, alanine aminotransferase; BUN, blood urea nitrogen; HDL, high density lipoprotein; LDL, low density lipoprotein; ICAM-1, intercellular adhesion molecule 1; VCAM-1, vascular cell adhesion molecule 1; sAxl, soluble Axl; Boldface indicates statistical significance.</p

Age-adjusted Spearman partial correlation coefficients between plasma Gas6 levels and tissue expression in CABG group.

*<p>Corrected for age. <b>^§</b>The logarithms of these variables were used for the analysis. CABG, coronary artery bypass grafting; Boldface indicates statistical significance.</p

Representative immunostaining, mRNA, real-time polymerase chain reaction, and the expression of Axl and growth arrest-specific protein 6 (Gas6) in cases 1 and 2 in the aorta.

<p>Case 1 showed high expression of Axl (A) and Gas6 (B), and case 2 represented low expression of Axl (C) and Gas6 (D). Isotype antibodies for Axl (E) and Gas6 (F) showed negative staining. Similarly, case 1 revealed increased Axl and Gas6 expression compared with that in case 2 in the mRNA (G), real-time polymerase chain reaction (H), and western blotting (I).</p

p53 expression is reduced by U-II at both mRNA and protein levels in HUVECs.

<p>(A) HUVECs were treated with DOX or DOX plus U-II. HUVECs were treated 24 h later with 1 µM DOX for the indicated time, and mRNA levels of p53 were evaluated by PCR. Equal RNA loadings were documented by GAPDH (lower). (B) HUVECs were treated with 1 µM DOX for the indicated time, and protein levels of p53 were evaluated by Western blotting. (C) HUVECs were treated with DOX or DOX plus U-II. HUVECs were treated 24 h later with or without 1 µM DOX for 24 h, and protein levels of p53 were evaluated by Western blotting. Densitometric data are means ± SEM from three separate experiments. *<i>P</i> <0.05 vs. control (Ctrl); ^#<i>P</i> <0.05 vs. DOX treatment.</p