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American Journal of Critical Care. 2008;17: 133-140
Copyright © 2008 by the American Association of Critical-Care Nurses.
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CE Article

Comparison of Sleep and Mood in Patients After On-Pump and Off-Pump Coronary Artery Bypass Surgery

By Christine Hedges, RN, PhD, APRN, BC, CCNS and Nancy S. Redeker, RN, PhD. Christine Hedges is a nurse researcher at Ann May Center for Nursing, Meridian Health, Neptune, New Jersey. Nancy S. Redeker is a professor and associate dean for scholarly affairs at the School of Nursing, Yale University, New Haven, Connecticut.

Corresponding author: Christine Hedges, RN, PhD, Ann May Center for Nursing, Jersey Shore University Medical Center, 1945 Rte 33, Neptune, NJ 07754 (e-mail: chedges{at}meridianhealth.com).

Background Off-pump coronary artery bypass surgical procedures have been advocated to reduce the adverse effects of cardiopulmonary bypass on the brain.

Objective To examine differences in objective and subjective characteristics of sleep and mood disturbance between patients after on-pump and off-pump coronary artery bypass surgery.

Methods In a secondary analysis of pooled data from 2 previous studies, sleep characteristics and mood disturbance on postoperative night 2 after transfer to the cardiac surgery step-down unit were compared in patients who had on-pump and off-pump cardiac surgery. The sample included 129 coronary artery bypass patients: 48 on-pump patients from one hospital and 81 off-pump patients from another hospital. Data were obtained with wrist actigraphs. Subjective characteristics of sleep were determined by using the Pittsburgh Sleep Quality Index and a sleep diary; mood disturbance was evaluated by using the short form of the Profile of Mood States.

Results Off-pump surgery was associated with better objective sleep continuity (decreased percentage of wake time after sleep onset and fewer awakenings) but not longer sleep duration after controlling for age and sex. The 2 groups of patients did not differ overall in subjective sleep characteristics, mood disturbance, or preoperative sleep quality.

Conclusion Use of off-pump coronary artery bypass surgery may improve sleep continuity during the early postoperative period. Prospective longitudinal studies are needed to evaluate the potential long-term benefits of this procedure during the different phases of recovery.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe the objective differences between characteristics of sleep in on- and off-pump coronary bypass patients.
  2. Identify the types of mood disturbances experienced by on- and off-pump coronary bypass patients.
  3. List 2 components associated with better objective sleep continuity in the off-pump coronary artery bypass group.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.






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Copyright © 2008 by the American Association of Critical-Care Nurses.