Evaluation of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease -- a randomised intervention study.

Aims And Objectives: To evaluate the effectiveness of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease.

Background: Recent scientific findings have shown that low physical exercise and stress interfere with coronary artery disease patients' sleep quality and sleep efficiency independent of gender, age and co-morbidity.

Design: A randomised pretest-post-test control design.

Methods: Forty-seven patients who had undergone a coronary revascularisation procedure and/or pharmacological treatment three to seven weeks earlier at a general hospital were randomised to either an intervention group or a control group. Data collection was carried out by questionnaires, a study-specific sleep diary and actigraphy registration for 10 consecutive 24-hour periods, with a follow-up after three to four months. The intervention group underwent a nurse-led individualised education programme to promote self-care of sleep-activity. Sleep habits and sleep-related lifestyle together formed the basis for setting up individual goals together with the nurse. Individual advice on physical training, relaxation exercise and a CD-based relaxation programme was provided by a physiotherapist. Both groups received a brochure about sleep and stress.

Results: At a three- to four-month follow-up, the main improvements were seen in the intervention group regarding sleep quality, sleep duration and sleep efficiency in the sleep diary and sleep efficiency in actigraphy. Statistical improvements in health-related quality of life were revealed. This was not so obvious in the control group.

Conclusions: An individualised intervention programme to promote self-care of sleep-activity including relaxation in patients with coronary artery disease led by a nurse may improve sleep quality. However, a longitudinal study to promote self-care in sleep-activity should be performed using a larger sample and multiple sites with continuous follow-ups to determine whether any positive effects remain stable over time.

Relevance To Clinical Practice: Implementation of a multiprofessional individualised programme to promote self-care of sleep-activity including relaxation based on patients' needs, supported by a healthcare team and led by nurses, is important in clinical practice.