1. Sleep and Nighttime Care in Adult Cardiac Surgery
Aaron Zalewski, Hillman Scholar & Jesus M. Casida, PhD, RN, APN-C, CCRN-CSC
University of Michigan School of Nursing, Ann Arbor, MI
Background and Significance
Specific Aims:
1. Describe subjects’ perceptions of nighttime sleep and daytime
function; and identify changes in nighttime sleep and daytime
function pre and post surgery.
2. Describe the relationship between nighttime sleep and daytime
function variables.
3. Describe nighttime routine care implemented during the
immediate post surgery period.
Conclusions
Patients’ perceived their nighttime sleep as “ineffective” throughout the
immediate post-operative period. Consequently, they required an
increased amount of daytime sleep (i.e., naps) to compensate for it.
Further research, involving a large and diverse sample size, is needed
to fully understand this phenomenon and examine to what extent
nighttime care routines or care processes affect patient sleep and
subsequent outcomes.
Nurses should lead the efforts in advancing sleep science in cardiac
surgery and are well positioned to transform care delivery processes at
night to promote patients’ sleep, health, and well-being.
Disrupted sleep is a common complaint among hospitalized patients.
However, in cardiac surgery, little is known about this problem.
Additionally, little is known about routine care delivered at night, which
purportedly disrupts patients’ sleep.
 Exploratory, repeated measures research design was employed
using data collected from 38 subjects, aged 37 to 90 years, who
participated in a clinical trial implemented in cardiothoracic ICU and
step-down units of an urban hospital in Michigan.
 All subjects underwent first time elective cardiac surgery using
cardiopulmonary bypass. Details of subjects’ demographics, clinical
characteristics, and study eligibility criteria are found in the handouts
below.
Variables & Measures:
 Nighttime sleep (sleep effectiveness) and daytime function (daytime
sleep supplementation) were measured with 6-item visual analog
sleep scales (100 mm horizontal lines):
 Nighttime routine care delivered during sleep hours (after midnight
and until 6AM) was recorded on a checklist by the bedside RN.
Figure 3 summarizes the “overall” NSE and DSS among the study
subjects. NSE was negatively correlated with DSS (r=-0.320, p=0.05).
Methods
Data Collection & Analysis:
 Pre-op data were obtained within 1 month prior to surgery.
 Post-op data were obtained during post-op nights (PON)/ post-op
days (POD) 1 through 5.
 Data were analyzed using descriptive and inferential statistics.
Results
Figure 2 summarizes the perceived DSS among the study subjects.
Post-op DSS component scores were higher than pre-op. Although
the changes in scores of each component (e.g., WAFA) were not
significant, the increase in the overall DSS scores from pre-op to post-
op were significant (F = 9.33, df = 5, η²p =0.66, p <0.001).
 Figure 1 summarizes the perceived NSE among the study subjects.
SQ and TST scores were lower on PON 3 to 4 and appeared to
return to pre-op on PON 5. However, these changes and variability in
scores were not significant (F = 4.65, df = 5, η²p =0.80, p >0.05).
Figure 1:
Figure 2:
Figure 3:
The table below summarizes the post-op nighttime routine care that
purportedly disrupts the subjects’ sleep.