title: Relevance of anxiety and stress levels on sleep quality after liver transplantation.
abstract: The goal of this study was to assess the effects of anxiety and stress on sleep quality in liver transplantation recipients. A prospective cross-sectional study was performed including 45 recipients enrolled at a liver transplantation program at Ribeirão Preto, State of São Paulo, Brazil. Anxiety and stress were evaluated by using a reduced version of the State-Trait Anxiety Inventory and the Perceived Stress Scale, respectively. Sleep quality and excessive daytime sleepiness were evaluated by using the Brazilian Portuguese versions of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. Thirty-two (71.11%) recipients presented with compromised sleep quality and 5 (11.11%) presented with excessive daytime sleepiness. Recipients with bad sleep quality had anxiety (mean, 26.91 points) and stress (mean, 17.88 points) levels that were higher than the levels of patients with normal sleep quality patterns, with anxiety levels presenting with statistically significant differences (P = .0420). Patients with above-average stress levels also had increased anxiety (mean, 28 points) and compromised sleep quality (mean, 7.03 points). In conclusion, a liver transplantation recipient who experiences bad sleep quality also has higher levels of anxiety and stress, suggesting a relationship between the sleep-wakefulness cycle and anxiety/stress. Planning strategies aimed at reducing such emotional shifts among recipients is of paramount importance. Therefore, new strategies focusing on improving the sleep pattern of patients are necessary because unhealthy sleep behavior may impair postoperative recovery.
authors.affiliation: General and Specialized Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil. Electronic address: dalsasso@eerp.usp.br.
authors.forename: K D S
authors.initials: KD
authors.lastname: Mendes
authors.affiliation: Special Liver Transplantation Unit, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: A R F
authors.initials: AR
authors.lastname: Lopes
authors.affiliation: Special Liver Transplantation Unit, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: T A
authors.initials: TA
authors.lastname: Martins
authors.affiliation: Special Liver Transplantation Unit, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: G F
authors.initials: GF
authors.lastname: Lopes
authors.affiliation: Special Liver Transplantation Unit, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: L C
authors.initials: LC
authors.lastname: Ziviani
authors.affiliation: Special Liver Transplantation Unit, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: F M
authors.initials: FM
authors.lastname: Rossin
authors.affiliation: Special Liver Transplantation Unit, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: O
authors.initials: O
authors.lastname: Castro-e-Silva
authors.affiliation: General and Specialized Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil.
authors.forename: C M
authors.initials: CM
authors.lastname: Galvão
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000523:psychology*; D011446:Prospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology