1047 SLEEP DISTURBANCE AND THE IMMUNOLOGICAL ACUTE PHASE RESPONSE IN POSTOPERATIVE HOSPITALIZED ADULTS.

Abstract

Introduction: Despite numerous studies documenting sleep disturbance in surgical patients, few studies have examined mechanisms that may contribute to disturbed sleep. Methods: This descriptive, repeated measures, correlational study examined subjective and objective sleep patterns, and inflammatory and stress responses in postoperative abdominal surgical patients to explore a possible relationship between sleep and biomarkers of inflammation and stress. Nineteen subjects, mean age 45.63 years (SD=11.44), were enrolled. Actigraphy was used to measure sleep variables over the postoperative period. Salivary biomarkers of the acute phase response IL 1-beta and TNF-alpha and stress response, cortisol, were collected at baseline, and on day 3 and 4. Subjective measures of sleep and systolic blood pressure were measured with biomarkers. Results: Sleep disturbance occurred in all subjects. Median total sleep time was 8.7 hours on day 1 and then declined to 6.8 hours on day 4, F=2.9, p < 0.05. Sleep efficiency median 83.8 % day 1 and decreased over the 4 days to 68.1%, F=6.3, p=0.001. Sleep onset latency within normal limits day 1 and outside the normal range on the remaining days as were number of awakenings and wake after sleep onset. Subjective sleep disturbance with fragmentation, increased sleep onset latency and supplemental daytime sleep was reported by all subjects. The IL1-beta measures greatly exceeded the normal range with pre-and postoperative measures >= 1070 pg/ml, and for 2 subjects levels were <10900 pg/ml during the 4 post-operative days of hospitalization. TNF-alpha levels were also elevated, with highest level range of 57.31 to 523.02 pg/ml during the 4 days of hospitalization. Preoperative cortisol levels were elevated. After the third night of sleep during hospitalization, there were significant between median sleep efficiency and IL1-beta (rs=0.76), median sleep onset latency and IL1-beta (rs = -0.55), and median sleep efficiency and TNF-alpha (rs=0.55). Correlations between subjective 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). Conclusion: Most patients experience disturbed sleep and exaggerated inflammatory responses.