The Association Between Sleep Disturbance, Depressive Symptoms, and Health-Related Quality of Life Among Cardiac Rehabilitation Participants

Abstract

Among participants of a CR program, disturbed sleep was strongly associated with depressive symptoms and decreased health-related quality of life. Results demonstrate the importance of sleep evaluation in CR programs.

Psychological Aspects of Cardiac Care and Rehabilitation: Time to Wake Up to Sleep?

“…Rather, studies have shown that sleep disturbance typically continues following a depressive episode [158], and residual insomnia symptoms following treatment for depression increase the risk of depressive relapse [159]. Insomnia is highly prevalent in cardiac patients (~ 37%) [160], and poor sleep quality is strongly associated with both depressive symptoms and decreased HRQoL in patients attending CR [161]. Furthermore, in patients recovering from a cardiac event (MI and/or revascularization) sleep disturbance was associated with poorer treatment adherence, and predicted anxiety and depression one year later [162].…”

Rehabilitation of Cardiovascular Disorders and Sleep Apnea

“…There is growing evidence that failure to treat OSA in cardiac patients can have a negative effect on postoperative recovery and increase mortality and morbidity, reduce quality of life, and lead to worse outcomes during and after the cardiac rehabilitation. 64,65 Hargenes and colleagues 66 studied patients entering an early outpatient cardiac rehabilitation program and found that cardiac patients with OSA had significantly lower cardiac output, stroke volume, and contractility index. They suggested that the decreased cardiac function in the OSA group, likely because of pressure and volume alteration associated with apneic events, may place these patients at a disadvantage in recovering from their cardiac events, and at increased risk for secondary complications.…”

“…84 In addition, they had slower recovery of functional abilities and longer stay in rehabilitation units. 10,85 These outcomes can lead to increased caregiving needs at home, nursing home placement, or death, 86 and may have detrimental effects on rehabilitation 64,87 and long-term outcome. 88 Functional independence in personal care activities can be measured using the motor subscale of the Functional Independence Measure (mFIM), 89 which is widely used in rehabilitation settings to assess functional limitations and changes in functional status with rehabilitation therapy.…”

“…92,93 These patients are less adherent to rehabilitation programs because of decreased functional capacity 94 and depression. 64,87 Poor sleep and fatigue are associated with neuropsychiatric and cognitive disturbances, and result in worse outcomes in rehabilitation and quality of life. 95 Depression after stroke occurs in 30% to 60% of patients with stroke 96 and poor sleep strongly correlates with health complaints and depressive symptoms.…”

Características da fadiga no pré e pós-operatórios de cirurgia de revascularização do miocárdio

“…Outro estudo verificou que 52% dos participantes em reabilitação cardíaca referiram presença de má qualidade do sono associada à diminuição da qualidade de vida relacionada à saúde desses indivíduos (215) . A relação do sono com a fadiga em pessoas no pré e pós-operatórios de cirurgia de RM é pouco conhecida e precisa ser melhor elucidada com novos estudos que consigam avaliar longitudinalmente a relação de causalidade entre presença de fadiga e pior qualidade do sono e os fatores que contribuem para a ocorrência de distúrbios do sono nessas pessoas.…”