Sleep Quality and Sleepiness in Persons with Implantable Cardioverter Defibrillators: Outcome from a Clinical Randomized Longitudinal Trial

• Type of Material: Article
• Authors: SELINA KIKKENBORG Berg, Rigshospitalet, The Heart Center, Copenhagen; Melinda K Higgins, Emory University; Carolyn Miller Reilly, Emory University; Jonathan J Langberg, Emory University; Sandra B Dunbar, Emory University
• Language: English
• Date: 2012-04-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1111/j.1540-8159.2011.03328.x
• Title of Journal or Parent Work: Pacing and Clinical Electrophysiology
• ISSN: 0147-8389
• Volume: 35
• Issue: 4
• Start Page: 431
• End Page: 443
• Grant/Funding Information: Supported in part by NIH NINR R01 5187 Psychoeducational Intervention for ICD Patients (PI-S. Dunbar).
• Keywords: Cardiac & Cardiovascular Systems; defibrillation-ICD; SYMPTOMS; CARDIAC-SURGERY; OF-LIFE ASSESSMENT; BREATHING DISORDERS; TELEPHONE INTERVENTION; Engineering, Biomedical; VENTRICULAR-ARRHYTHMIAS; Science & Technology; HEALTH; Cardiovascular System & Cardiology; clinical trials; Engineering; Life Sciences & Biomedicine; HEART-FAILURE; ARTERY-BYPASS-SURGERY; ASSOCIATION; Technology
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Background: Patients receiving an implantable cardioverter defibrillator (ICD) report various types and degree of sleep disruptions, but little is known regarding their characteristics, duration, and associated factors. The purposes of this study were: (1) to describe the effect of a psychoeducational intervention on sleep quality and daytime sleepiness, (2) to describe patterns of sleep over time, and (3) to identify predictors of poor sleep in an ICD population. Methods: A randomized longitudinal intervention trial was designed to test the effects of a psychoeducational intervention, which included a sleep education and counseling session in patients receiving their initial ICD. Patients (n = 236; 75% men; mean age 58.4 [±11.2] from the PsychoEducationAl Intervention for ICD PatiEnts (PEACE) trial comprised the study population. Variables related to sleep were measured by the Pittsburgh Sleep Quality Inventory (PSQI) and Epworth Sleepiness Scale (ESS). Results: No psychoeducational intervention effects on sleep outcomes were observed. However, 67.2% of the patients reported poor sleep quality at baseline, and 56.8% had low sleep quality at 6 months based on PSQI scores > 5; one-third (32.6%) were excessively sleepy based on ESS scores ≥10 at 6 months. Anxiety, depression, physical function, pain intensity, and pain severity were all highly correlated to each other across time. Female gender was a significant covariate for the PSQI. New York Heart Association (NYHA) class was a significant covariate for sleepiness (Epworth). Conclusions: Low sleep quality and daytime sleepiness are found at time of insertion and over time in patients with ICD. Female gender, higher NYHA class, as well as two latent factors encompassing increased anxiety, depressive symptoms, and decreased physical function and increased pain, were significant predictors of poor sleep quality and sleepiness over time. These data help identify those at higher risk for sleep problems after ICD.