Hemodynamics Changes in the Phase Before, During, and After Sleep Based on Patients’ Sleep Quality in High Care Unit

Sri Suparti; Darono Darono; Nurul Fatwati Fitriana; Nastiti Asri Wijaya

doi:10.3889/oamjms.2021.5819

Authors

Sri Suparti Nursing Study Program, Faculty of Health Sciences, Universitas Muhammadiyah Purwokerto, Banyumas, Indonesia https://orcid.org/0000-0003-3544-2848
Darono Darono Intensive Care Unit Nurse, Prof. Dr. Margono Soekarjo Hospital, Banyumas, Indonesia https://orcid.org/0000-0003-1546-2665
Nurul Fatwati Fitriana Nursing Study Program, Faculty of Health Sciences, Universitas Muhammadiyah Purwokerto, Banyumas, Indonesia
Nastiti Asri Wijaya Nursing Study Program, Faculty of Health Sciences, Universitas Muhammadiyah Purwokerto, Banyumas, Indonesia https://orcid.org/0000-0002-1670-1528

DOI:

https://doi.org/10.3889/oamjms.2021.5819

Keywords:

Hemodynamic, Sleep, HCU, MAP, SpO2

Abstract

BACKGROUND: Sleep is a human physiological need that must be fulfilled. Sleep disturbance is generally experienced by hospitalized patients and measured by sleep quality. Sleep disturbance can adversely affect hemodynamic parameters, physiological, and psychological outcome that contribute to the healing of patients. However, few literatures discussing the hemodynamic changes based on the patients’ sleep quality.

AIM: The study aimed to describe the hemodynamic changes before, during, and after sleeping phases

METHODS: This is an observational analytic quantitative study conducted between February and March 2019 and involved 45 patients. The samples were the conscious patients, aged between 18 and 60 years old (adult) and had been hospitalized for more than 2 days. The Richards-Campbell Sleep Questionnaire was utilized to measure the patients sleep quality, while hemodynamic values were observed by patients’ bedside monitor before, during and after sleep. Data analysis used the Friedman test to determine hemodynamic changes.

RESULTS: The results showed that most respondents were female (75.6%), used oxygen (46.7%), sleep in supine position (55.6%), and average age of 35.47 (standard deviation [SD] = 9.581) years old. Patients’ sleep quality score was 44.27 (SD = 22.809), with the average days of treatment were 2.47 days (SD = 694). The average score of Hemodynamic Mean Arterial Pressure (MAP), Heart Rate (HR), and Oxygen saturation (SpO2) before sleeping was 97.64, 94.04, and 94.09, during sleeping was 89.87, 85.00, and 91.22 while after sleeping was 98.27, 97.56, and 97.89, respectively. There was a significant change in HR with p = 0.019, and there was no significant change in the MAP (p = 0.152) and SpO2 (p = 0.149)

CONCLUSION: There were variations in hemodynamic score changes before, during, and after sleep, changes in MAP, HR, and SpO2 score within normal ranges. The high hemodynamic changes in the early phase, decrease during sleep, and rise again after sleep. HR is a hemodynamic parameter that significantly changes in those three phases. Monitoring of hemodynamic values in patients could be carried out in the before, during, and after sleep phases to determine the patients’ physiological and psychological condition so as to contribute the healing process.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Tobaldini E, Cogliati C, Fiorelli EM, Nunziata V, Wu MA, Prado M, et al. One night on-call: Sleep deprivation affects cardiac autonomic control and inflammation in physicians. Eur J Intern Med. 2013;24(7):664-70. https://doi.org/10.1016/j.ejim.2013.03.011 PMid:23601527 DOI: https://doi.org/10.1016/j.ejim.2013.03.011

Tobaldini E, Pecis M, Montano N. Effects of acute and chronic sleep deprivation on cardiovascular regulation. Arch Ital Biol. 2014;152(2-3):103-10. PMid:25828682

Tobaldini E, Costantino G, Solbiati M, Cogliati C, Kara T, Nobili L, et al. Sleep, sleep deprivation, autonomic nervous system and cardiovascular diseases. Neurosci Biobehav Rev. 2017;74(Pt B):321-9. https://doi.org/10.1016/j.neubiorev.2016.07.004 PMid:27397854 DOI: https://doi.org/10.1016/j.neubiorev.2016.07.004

Berman A, Snyder SJ, Frandsen G. Kozier and Erb’s Fundamentals of Nursing Concepts, Process, and Practice. 10th ed. San Francisco: Pearson Publishing Company; 2016.

Zhang DY, Anderson AS. The sympathetic nervous system and heart failure. Cardiol Clin. 2014;32(1):33-45. PMid:24286577 DOI: https://doi.org/10.1016/j.ccl.2013.09.010

Calhoun DA, Harding SM. Sleep and hypertension. Chest. 2010;138(2):434-43 PMid:20682533 DOI: https://doi.org/10.1378/chest.09-2954

Boyko Y, Toft P, Oerding H, Lauridsen JT, Nikolic M. 38th International Symposium on Intensive Care and Emergency Medicine. Meeting Abstracts. Brussels, Belgium: International Symposium on Intensive Care and Emergency Medicine; 2018. https://doi.org/10.1186/s13054-018-1973-5 DOI: https://doi.org/10.1186/s13054-018-1973-5

Słomko J, Zawadka-Kunikowska M, Klawe JJ, Tafil-Klawe M, Newton J, Zalewski P. Cardiovascular regulation and body temperature: Evidence from a nap vs. sleep deprivation randomized controlled trial. Physiol Res. 2018;67(5):687-93. https://doi.org/10.33549/physiolres.933758 PMid:30433809 DOI: https://doi.org/10.33549/physiolres.933758

Pooni JS, Jevon P, Ewens B. Monitoring the Critically Ill Patient. 3rd ed. Chichester, England: Wiley-Blackwell; 2012. https://doi.org/10.1002/9781118702932 DOI: https://doi.org/10.1002/9781118702932

Truijen J, Van Lieshout JJ, Wesselink WA, Westerhof BE. Noninvasive continuous hemodynamic monitoring. J Clin Monit Comput. 2012;26(4):267-78. https://doi.org/10.1007/s10877-012-9375-8 PMid:22695821 DOI: https://doi.org/10.1007/s10877-012-9375-8

Triyanta T, Haryati DS. Hubungan Antara Kulaitas tidur dengan Denyut Jantung dilihat dari Gambaran EKG pasien Ifark Miokard di Ruang ICVCU RSUD Dr. Moewardi Surakarta. Surakarta: LPPM Universitas Kusuma Husada Surakarta; 2011. p. 124-31. https://doi.org/10.37341/jkg.v2i1.28 DOI: https://doi.org/10.37341/jkg.v2i1.28

Kaplow R. Sleep disturbances and critical illness. Crit Care Nurs Clin North Am. 2016;28(2):169-82. PMid:27215355 DOI: https://doi.org/10.1016/j.cnc.2016.02.005

Ding Q, Redeker NS, Pisani MA, Yaggi HK, Knauert MP. Factors influencing patients’ sleep in the intensive care unit: Perceptions of patients and clinical staff. Am J Crit Care. 2017;26(4):278-86. https://doi.org/10.4037/ajcc2017333 PMid:28668912 DOI: https://doi.org/10.4037/ajcc2017333

Hadi H. Factors Affecting Sleep Disorders of Patients in the Intensive Care Unit. Semarang, Indonesia: Proceedings of the International Conference on Applied Science and Health; 2017.

Carrera-Hernández L, Aizpitarte-Pejenaute E, Zugazagoitia- Ciarrusta N, Goñi-Viguria R. Patients’ perceptions of sleep in a critical care unit. Enferm Intensiva. 2018;29(2):53-63. https://doi.org/10.1016/j.enfie.2018.01.002 PMid:29605589 DOI: https://doi.org/10.1016/j.enfie.2018.01.002

Sulistyowati D. Pengaruh Sudut Posisi Terhadap Kualitas Tidur Dan Status Kardiovaskuler Pada Pasien Infark. Jurnal Kusuma Husada. 2015;858:75-80.

Lian Y, Yuan Q, Wang G, Tang F. Association between sleep quality and metabolic syndrome: A systematic review and meta-analysis. Psychiatry Res. 2019;274:66-74. https://doi.org/10.1016/j.psychres.2019.01.096 PMid:30780064 DOI: https://doi.org/10.1016/j.psychres.2019.01.096

Culver MN, Langan SP, Carreker J, Flatt AA, Ratchford SM, Grosicki GJ. Self-reported sleep quality is associated with central hemodynamics in healthy individuals. Sleep Breath. 2020;24(3):1083-8. https://doi.org/10.1007/s11325-020-02082-5 PMid:32328930 DOI: https://doi.org/10.1007/s11325-020-02082-5

Fang J, Wheaton AG, Keenan NL, Greenlund KJ, Perry GS, Croft JB. Association of sleep duration and hypertension among us adults varies by age and sex. Am J Hypertens. 2012;25(3):335-41. https://doi.org/10.1038/ajh.2011.201 PMid:22052075 DOI: https://doi.org/10.1038/ajh.2011.201

Wang Y, Mei H, Jiang YR, Sun WQ, Song YJ, Liu SJ, et al. Relationship between duration of sleep and hypertension in adults: A meta-analysis. J Clin Sleep Med. 2015;11(9):1047-56. https://doi.org/10.5664/jcsm.5024 PMid:25902823 DOI: https://doi.org/10.5664/jcsm.5024

Beltrami FG, Nguyen XL, Pichereau C, Maury E, Fleury B, Fagondes S. Sleep in the intensive care unit. J Bras Pneumol. 2015;41(6):539-46. https://doi.org/10.1590/s1806-37562015000000056 PMid:26785964 DOI: https://doi.org/10.1590/s1806-37562015000000056

Pulak LM, Jensen L. Sleep in the intensive care unit: A review. J Intensive Care Med. 2016;31(1):14-23. https://doi.org/10.1177/0885066614538749 PMid:24916753 DOI: https://doi.org/10.1177/0885066614538749

Kamdar BB, Needham DM, Collop NA. Sleep deprivation in critical illness: Its role in physical and psychological recovery. J Intensive Care Med. 2012;27(2):97-111. https://doi.org/10.1177/0885066610394322 PMid:21220271 DOI: https://doi.org/10.1177/0885066610394322

Bihari S, Doug McEvoy R, Matheson E, Kim S, Woodman RJ, Bersten AD. Factors affecting sleep quality of patients in intensive care unit. J Clin Sleep Med. 2012;8(3):301-7. https://doi.org/10.5664/jcsm.1920 PMid:22701388 DOI: https://doi.org/10.5664/jcsm.1920

Yilmaz M, Sayin Y, Gurler H. Sleep quality of hospitalized patients in surgical units. Nurs Forum. 2012;47(3):183-92. https://doi.org/10.1111/j.1744-6198.2012.00268.x PMid:22861655 DOI: https://doi.org/10.1111/j.1744-6198.2012.00268.x

Kita T, Yoshioka E, Satoh H, Saijo Y, Kawaharada M, Okada E, et al. Short sleep duration and poor sleep quality increase the risk of diabetes in Japanese workers with no family history of diabetes. Diabetes Care. 2012;35(2):313-8. https://doi.org/10.2337/dc11-1455 PMid:22210572 DOI: https://doi.org/10.2337/dc11-1455

Ekayanti MS, Bachtiar MF, Mawuntu AH, Pertiwi JM. Pertiwi, Irama Sirkadian pada Stroke Akut. J. Sinaps. 2019;2(1):9-18.

Kulpatcharapong S, Chewcharat P, Ruxrungtham K, Gonlachanvit S, Patcharatrakul T, Chaitusaney B, et al. Sleep quality of hospitalized patients, contributing factors, and prevalence of associated disorders. Sleep Disord. 2020;2020:8518396. https://doi.org/10.1155/2020/8518396 PMid:32308998 DOI: https://doi.org/10.1155/2020/8518396

Boudreau P, Yeh WH, Dumont GA, Boivin DB. Circadian variation of heart rate variability across sleep stages. Sleep. 2013;36(12):1919-28. https://doi.org/10.5665/sleep.3230 PMid:24293767 DOI: https://doi.org/10.5665/sleep.3230

Cabiddu R, Cerutti S, Viardot G, Werner S, Bianchi AM. Modulation of the sympatho-vagal balance during sleep: Frequency domain study of heart rate variability and respiration. Front Physiol. 2012;3:45. https://doi.org/10.3389/ fphys.2012.00045 DOI: https://doi.org/10.3389/fphys.2012.00045

PMid:22416233

Sajjadieh A, Shahsavari A, Safaei A, Penzel T, Schoebel C, Fietze I, et al. The association of sleep duration and quality with heart rate variability and blood pressure. Tanaffos. 2020;9(2):135-43.

PMid:33262801

Pamidi S, Marc I, Simoneau G, Lavigne L, Olha A, Benedetti A, et al. Maternal sleep-disordered breathing and the risk of delivering small for gestational age infants: A prospective cohort study. Thorax. 2016;71(8):719-25. https://doi.org/10.1136/ thoraxjnl-2015-208038 DOI: https://doi.org/10.1136/thoraxjnl-2015-208038

PMid:27084956

Widiyanto B, Yamin LS. Terapi Oksigen Terhadap Perubahan Saturasi Oksigen Melalui Pemeriksaan Oksimetri pada Pasien Infark Miokard akut (IMA). Semarang, Indonesia: Universitas Muhammadiyah Semarang; 2014. https://doi.org/10.7454/jki. v12i1.194 DOI: https://doi.org/10.7454/jki

Noviyanti HA, Sutrisna M, Kusmiran E. Hubungan Intensitas Nyeri dengan Kualitas Tidur pada Pasien Pasca Bedah Sesar. Jurnal Persatuan Perawat Nasional Indonesia (JPPNI). 2020;4(2):179. https://doi.org/10.32419/jppni.v4i2.179 DOI: https://doi.org/10.32419/jppni.v4i2.179

Lee JH. Difference in effects on sleep quality and stress depending on anesthetic methods in women who underwent cesarean section in Korea. Rawal Med J. 2016;41(4):1.

Istiyani D, Kristiyawati SP. Perbedaan posisi tripod dan posisi semi fowler terhadap peningkatan saturasi oksigen pada pasien asma di rs paru Dr. Ario Wirawan Salatiga. J Ilmu Keperawatan Kebidanan. 2015;4:1-10. https://doi.org/10.32668/jkep.v4i1.278 DOI: https://doi.org/10.32668/jkep.v4i1.278

Kusumawati N. Efektifitas Posisi Tidur Semi Fowler Dengan Kualitas Tidur Pada Pasien Asma Di Ruang Rawat Inap Perawatan Paru Rsud Bangkinang Tahun 2017. Pretotif J. Kesehat. Masy. 2017;1(2):55-64. https://doi.org/10.32807/jmu. v1i1.42

Maria I, Hasaini A. The effect of semi fowler position on the stability of breathing among asthma patients at ratu Zalecha hospital martapura. In: Proceedings of the Third International Conference on Sustainable Innovation 2019 – Health Science and Nursing. Switzerland: Atlantis Press; 2019. p. 242. https:// doi.org/10.2991/icosihsn-19.2019.52 DOI: https://doi.org/10.2991/icosihsn-19.2019.52

Basoglu OK, Keskin B, Tasbakan MS, Gurgun C. Effect of semirecumbent sleep position on severity of obstructive sleep apnea in patients with heart failure. J Card Fail. 2015;21(10):842- 7. https://doi.org/10.1016/j.cardfail.2015.06.004 DOI: https://doi.org/10.1016/j.cardfail.2015.06.004

PMid:26091958

Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14. https://doi.org/10.1093/ aje/kws342 DOI: https://doi.org/10.1093/aje/kws342

PMid:23589584

Schober AK, Neurath MF, Harsch IA. Prevalence of sleep apnoea in diabetic patients. Clin Respir J. 2011;5(3):165-72. https://doi.org/10.1111/j.1752-699x.2010.00216.x DOI: https://doi.org/10.1111/j.1752-699X.2010.00216.x

PMid:21679352

Knauert MP, Yaggi HK, Redeker NS, Murphy TE, Araujo KL, Pisani MA. Feasibility study of unattended polysomnography in medical intensive care unit patients. Heart Lung. 2014;43(5):445- 52. https://doi.org/10.1016/j.hrtlng.2014.06.049 DOI: https://doi.org/10.1016/j.hrtlng.2014.06.049

PMid:25023504

Tamisier R, Weiss JW, Pépin JL. Sleep biology updates: Hemodynamic and autonomic control in sleep disorders. Metabolism. 2018;84:3-10. https://doi.org/10.1016/j. metabol.2018.03.012 DOI: https://doi.org/10.1016/j.metabol.2018.03.012

PMid:29572132

Potter PA, Perry AG, Stockert PA, Hall AM. Fundamental of Nursing. 8th ed. St. Louis, MO: Mosby; 2013.