Factors associated with the attempted length, disturbance, effectiveness, and nap supplementation of sleep were analyzed in 97 patients recovering from cardiac surgery a few days before hospital discharge. Patients rated sleep for the prior night and factors that impaired their sleep after transfer from the critical care unit. The group averaged little sleep, with moderate disturbance and effectiveness and low nap supplementation. The disturbance, effectiveness, and attempted length of sleep were associated with an inability to perform their usual routine before sleep, inability to get comfortable, pain, noises, procedural care, and an unfamiliar bed. Patients encounter difficulties with sleep, even near discharge from the hospital. Interventions should be tested to mitigate specific factors that affect selected dimensions of sleep.

BACKGROUND: Effective management of sleep disturbances after cardiac surgery requires insight into patients perceptions of which factors disturb sleep in the intensive care unit and after transfer from the intensive care unit. OBJECTIVE: To describe patients perceptions of environmental factors that disturbed sleep after cardiac surgery. SAMPLE: A convenience sample of 102 patients was surveyed in a 300-bed, acute-care teaching hospital. METHOD: Patients were interviewed several days before discharge from the hospital and rated the extent to which specific factors disturbed their sleep while in the intensive care unit and after transfer. RESULTS: The group mean for the extent of disturbance scores, averaged across all 35 environmental factors studied, was low during and after stay in the intensive care unit. However, selected items such as pain, and inability to get comfortable and perform a familiar nighttime routine, were moderately disturbing to many patients across phases of recovery. Patients varied widely in the number of factors, ranging from 0 to 33 factors, that disturbed sleep at least to some extent. Patients added factors that were not included in the original monitoring instrument. CONCLUSIONS: Patients attribute disturbed sleep to specific factors after cardiac surgery. The number of factors that disturb sleep varies among patients. Nurses can modify many of the factors that disturb sleep to promote an environment that will facilitate improved sleep, thereby enhancing the acute phase of recovery from cardiac surgery.

BACKGROUND: Up to 50% of patients who undergo cardiac surgery report problems with sleep after cardiac surgery. Knowledge about which individual factors are associated with sleep problems after cardiac surgery would help nurses identify patients who are at greater risk for sleep problems during hospitalization. OBJECTIVE: To compare patients perceptions of sleep before and during hospitalization for cardiac surgery and identify and analyze individual factors in relation to patients perceptions of sleep. METHOD: A sample of 102 patients who underwent elective or emergent cardiac surgery were studied at a 300-bed teaching hospital in the northwestern United States. A few days before their anticipated discharge from the hospital, consenting patients completed questions about their sleep before hospitalization and the night before their interview. RESULTS: Patients reported that they slept fewer hours in the hospital than at home. No differences were found in patients perceived depth and sufficiency of sleep, or refreshment before and after surgery. Patients who slept poorly at home did not report any worse sleep after surgery than patients who slept well at home. Women's perceptions about the sufficiency, refreshment, and quality of sleep were consistent before and after surgery, but no relationships were found among men's ratings. The length of sleep at home was positively related to the length of sleep after surgery in older patients. CONCLUSIONS: Sleep length is related to patients perceptions of sleep after cardiac surgery. Gender and age are also related to qualitative aspects of sleep before and after surgery and can be instrumental in an individualized assessment of sleep patterns anticipated after cardiac surgery.