The Effects of Cardiac Rehabilitation on Sleep Quality and Sleep Duration in Patients After Coronary Artery Bypass Graft

Study Overview
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Brief Summary
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This study aims to investigate the effects of cardiac rehabilitation on sleep quality and sleep duration in patients after coronary artery bypass graft.

Detailed Description
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Coronary artery disease (CAD) is one of the common cardiovascular diseases, including myocardial infarction and unstable angina pectoris. Using the Global Burden of Disease statistical data analysis in 2020, Khan and other scholars found that the global prevalence of CAD is about 1,655 per 100,000 people, and the prevalence rate in Taiwan is about 1759 per 100,000 people, slightly higher than the global prevalence rate. Therefore, all countries in the world attach great importance to the prevention and treatment of CAD. In addition to common risk factors such as age, metabolic disease, smoking, and poor lifestyle habits such as insufficient physical activity, the literature indicates that sleep quality and sleep duration are also significantly associated with CAD. A 2011 meta-analysis by Francesco et al. pointed out that people who sleep less than 5 hours have a higher risk of CAD and are significantly associated with higher mortality rate. Patients with CAD who self-reported poor sleep quality and short sleep duration still had a high proportion after heart-related treatment. In 1993, Redeker tracked the related symptoms of patients after coronary artery bypass graft(CABG) and found that the sleep disturbance of patients did not improve, but increased. A systematic review of the literature by Liao et al. also found similar results. The sleep quality and sleep duration of patients after CABG can be improved over time, but a high proportion of patients still complain of sleep disturbance. Therefore, the influence of sleep disturbance in patients with CAD will persist, and studies have also suggested that persistent sleep disturbance will increase the readmission rate and mortality rate of patients with CAD. Therefore, it is very important to actively manage the sleep quality and sleep time of patients with CAD.

Official Title
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The Effects of Cardiac Rehabilitation on Sleep Quality and Sleep Duration in Patients After Coronary Artery Bypass Graft: A Randomized Control Trial

Conditions
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Coronary Artery Disease, Coronary Artery Bypass Graft, Sleep Quality, Cardiac Rehabilitation

Intervention / Treatment
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* Other: Cardiac rehabilitation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age between 40-80 years old Have undergone CABG The score of PSQI > 5 Can accomplish with instructions and complete the evaluation process Body mass index less than 35 Kg/m2 Exclusion Criteria: Diagnosed with Sleep apnea (e.g., obstructive sleep apnea, and central sleep apnea) Drug or alcohol dependence Psychology disease Neurological or musculoskeletal disorders that may interfere with CR Uncontrolled cardiac status (e.g., unstable angina, and uncontrolled arrhythmia) Women in pregnancy

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cardiac rehabilitation group<br> | Other: Cardiac rehabilitation<br>* Using Cardiac rehabilitation for patients after coronary artery bypass graft<br>|
| No Intervention: Control group<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pittsburgh Sleep Quality Index (PSQI) | Range of 0-21, higher scores indicate worse sleep quality. Scores > 5 are taken to represent poor sleep quality | Change between baseline and 3 mons. after cardiac rehabilitation | 
| Actigraphy | Objective sleep parameter. Wear on the non-dominant wrist for 24 hrs. Can measure the total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE) | Change between baseline and 3 mons. after cardiac rehabilitation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Epworth Sleepiness Scale (ESS) | General level of daytime sleepiness . 8 self-rated questions. The chance of dozing is rated on a scale of 0-3. Range of 0-24, higher scores indicate worse daytime sleepiness. Scores > 10 are taken to represent excessive daytime sleepiness. | Change between baseline and 3 mons. after cardiac rehabilitation | 
| Visual analogue scale | Pain rating scales. Mark a 100 mm line to indicate pain intensity. 0 mm = no pain, 100 mm = worst pain | Change between baseline and 3 mons. after cardiac rehabilitation | 
| Hospital Anxiety and Depression Scale (HADS) | Range of 0-21, higher scores indicate worse anxiety or depression. Scores > 10 are taken to represent anxiety or depression | Change between baseline and 3 mons. after cardiac rehabilitation | 
| Cardiopulmonary exercise testing (CPET) | Gold standard for exercise capacity. Protocol: Starting form 0 watt, increase 10-15 watt/min. Test termination: Reach ≥ 85% of maximal HR, Respiratory exchange ratio (RER) > 1.10, Participants feel exhausted | Change between baseline and 3 mons. after cardiac rehabilitation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Coronary Artery Disease, Coronary artery bypass graft, Sleep quality, Sleep duration, Cardiac rehabilitation