Access Type

Open Access Dissertation

Date of Award

January 2017

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Nursing

First Advisor

Patricia A. Jarosz

Abstract

Abstract

Sleep Disturbance and the Immunological Acute Phase Response

in Postoperative Hospitalized Adults

Abstract

The purpose of this study was to examine the subjective and objective (actigraphy) sleep patterns, the immunological acute phase response of IL1-β and TNF-α, and the physiological stress response of cortisol and systolic blood pressure in post-operative abdominal surgical patients. Nineteen subjects, 10 men and 9 women, mean age 45.63 years (SD = 11.44) were enrolled between April 2015 and March 2016. All subjects were elective major invasive abdominal surgery patients. Laparoscopic surgery occurred in 10 patients and incisional surgery occurred in 9 patients. This descriptive correlational design included the sleep questionnaires Verran-Snyder-Halpern Sleep Scale and the Subjective Sleep Quality Questionnaire. Time in bed, total sleep time, sleep latency, sleep efficiency, wake after sleep onset, and night-time awakenings actigraph measures from day of surgery to morning of discharge, and 5 submitted saliva samples for baseline, 6 a.m. and 6 p.m. interleukin1-β, tumor necrosis factor-α, and cortisol.

Sleep disturbance, both subjective and objective, occurred in all 19 subjects. Sleep disturbance with fragmentation, sleep latency and supplemental daytime sleep was reported by all subjects. Time in bed and total sleep decreased on day 2 and 3, with an increase on Day 4. Sleep latency range was 0 to over 300 minutes on all days. Wake after sleep onset ranged from 0 to over 300 minutes during the 4 days. Frequent night-time awakenings mean = 62.94 (SD= 49.61) for day 1and 2. The immunological acute phase response of IL1-β measures greatly exceeded the normal range with pre- and post-operative measures ≤ 1070 pg/ml, and for 2 subjects, levels were <10900 pg/ml during the 4 post-operative days of hospitalization. TNF-α levels were also elevated, with highest level range of 57.31 to 523.02 pg/ml during the 4 days of hospitalization. Pre-operative cortisol levels were elevated; on day 4, 11 subjects’ cortisol levels were within normal range. After the third night of sleep during hospitalization, there were positive correlations between VSH sleep effectiveness scale and cortisol was r = 0.62 (p < 0.006); sleep effectiveness and systolic blood pressure was r = 0.55 (p < 0.014). Actigraphy time in bed to total sleep time was r =0.70 (p < 0.002); time in bed to wake after sleep time was r =0.55 (p < 0.026); time in bed to night-time awakenings was r =0.57 (p < 0.020); total sleep time to sleep efficiency was r = 0.65 (p < 0.006); total sleep time to wake after sleep onset was r = 0.78 (p < 0.000); time in bed to night-time awakenings was r =0.69 (p < 0.003); sleep efficiency to wake after sleep onset was r =0.50 (p < 0.049); wake after sleep onset to night-time awakenings was r =0.90 (p < 0.000); and IL1-β to TNF-α was r = 0.70 ( p < 0.001).

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