Summary

Sleep deficit is not uncommon in cardiac surgery patients, but research in this area is limited.
This article examines the processes involved in sleep and how promoting these processes can
optimise recovery in cardiac surgery patients. The two main parts of sleep, non-rapid eye
movement and rapid eye movement, are believed to be responsible for the physical and
psychological repair of the body. The combination of surgical injury, underlying disease and
increased stress levels during hospitalisation for cardiac surgery increases the need for this
repair. Nurses with a good understanding of sleep theories and the nursing process can use
sleep and rest as an intervention to promote healing and prevent further injury after surgery.

THE HIGH number of cardiac surgery procedures now performed in the UK and the
accompanying pressure to reduce waiting lists have led to a decrease in the length of hospital
stay for patients in this group. Providing optimum recovery in a relatively short space of time
demands attention to detail in nursing care.

The effects of sleep and rest on the recovery of hospital patients are widely researched in
health care in general, and to a lesser extent in relation to cardiac surgery. Sleep deficit is not
uncommon during recovery from cardiac surgery and may affect quality of life, morbidity
and mortality (Hirsch and Howard 1999, Redeker and Hedges 2002). Correlating the theories
of sleep and its physiological effects is of particular importance in this patient group in terms
of the adverse effects inappropriate autonomic nervous system arousal can have on the
physiological system (Weiss 2001).

In the literature the focus is towards the promotion of sleep as being essential to the psycho-
physiologic repair and restoration of the body (Chokroverty 1999, Redeker 2002). Even
though the functions of sleep are not yet proven (Hetta 1999), the detrimental effects of sleep
deprivation are well documented (Hetta 1999, Chokroverty 1999).

The length of hospital stay for cardiac surgical patients is decreasing and, as a result, it is
becoming increasingly necessary before discharge to spend more time preparing patients for
their return home. Sleep and rest have an important role in enabling the physical activities
that are required for physical and psychological restoration following cardiac surgery. Patient
surveys have shown that fatigue and sleeplessness persist for up to six months after cardiac
surgery, and subjectively affect quality of life (Hunt et al 2000).

The overall aim of the nurse caring for a patient who has undergone cardiac surgery is
achieving and maintaining cardiovascular stability and pulmonary sufficiency to meet the
body's metabolic requirements (Hatchett and Thompson 2002). Added to this is the need to
protect myocardial tissue from ischaemia, infarction or the undoing of the surgery performed
(Finkelmeier 2000). This article explores the effects of sleep or lack of sleep on achieving
these aims.

Epidemiology

The number of revascularisation procedures in the UK has doubled in the past ten years
(Figure 1). Interventions for coronary revascularisation occur in high proportions in older
people, and the continuing increase in the number of older people in the UK may see a further
rise in these interventions. Poor quality and fragmented sleep is also more prevalent in the
older age groups (Dew et al 2003), with those aged over 55 years being most affected by
insomnia (Morgan and Closs 1999). The extent of sleep deficit following cardiac surgery
varies between different surveys and studies. In one survey, 17 per cent of respondents
reported poor sleep quality 12 months after cardiac surgery (Hunt et al 2000), while another
study showed that most patients found their sleep patterns returned to pre-operative levels
one month after surgery