Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
School of Health and Welfare, Jönköping University, Jonkoping, Sweden.
BMJ Open. 2021 Jan 7;11(1):e039959. doi: 10.1136/bmjopen-2020-039959.
Sleep disturbances and delirium are frequently observed complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve implantation (TAVI), especially in octogenarian patients. However, a knowledge gap exists on patient experiences of sleep and delirium. In particular, patients' long-term sleep and delirium experiences are unknown. This article explores and describes how octogenarian patients suffering from delirium after aortic valve replacement experience their sleep and delirium situation.
An explorative and descriptive design with a longitudinal qualitative approach was applied. Qualitative content analysis following the recommended steps of Graneheim and Lundman was performed.
Patients were included at a tertiary university hospital with 1400 beds. Delirium and insomnia screening was performed at baseline and five postoperative days after aortic valve treatment. For qualitative data, 10 patients were interviewed 6-12 months after treatment with focus on delirium. Five of these patients were reinterviewed 4 years after treatment, with focus on their sleep situation.
Inclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium after treatment.
For the initial interview, we included five men and five women, four following TAVI and six following SAVR, mean age 83. One overarching theme revealed from the content analyses; . Whereas three subthemes described the patients' experiences with sleep and delirium, a cascade of distressful experiences disturbing sleep and . Four years after the treatment, sleep disturbances persisted, and patients still remembered strongly the delirium incidences.
For octogenarian patients, sleep disturbances and delirium are long-term burdens and need a greater attention in order to improve patient care.
睡眠障碍和谵妄是心脏主动脉瓣置换术（SAVR）和经皮主动脉瓣植入术（TAVI）后常见的并发症，尤其是在 80 岁以上的患者中。然而，目前对于患者的睡眠和谵妄体验仍存在知识空白。特别是，患者长期的睡眠和谵妄体验尚不清楚。本文探讨并描述了主动脉瓣置换术后出现谵妄的 80 岁以上患者对其睡眠和谵妄状况的体验。
采用纵向定性探索性描述设计。采用 Graneheim 和 Lundman 推荐的步骤进行定性内容分析。
患者在一所拥有 1400 张床位的三级大学医院接受治疗。在主动脉瓣治疗前和治疗后 5 天进行谵妄和失眠筛查。对于定性数据，在治疗后 6-12 个月对 10 名患者进行了以谵妄为重点的访谈。其中 5 名患者在治疗 4 年后再次接受访谈，重点关注他们的睡眠情况。
纳入标准；年龄 80 岁以上，接受 SAVR 或 TAVI 治疗，且治疗后出现谵妄。
在最初的访谈中，我们纳入了 5 名男性和 5 名女性，其中 4 名接受 TAVI 治疗，6 名接受 SAVR 治疗，平均年龄为 83 岁。内容分析揭示了一个总体主题；。而三个副标题描述了患者对睡眠和谵妄的体验，即一连串令人痛苦的经历扰乱了睡眠和。治疗 4 年后，睡眠障碍仍然存在，患者仍然强烈记得谵妄发作。
对于 80 岁以上的患者，睡眠障碍和谵妄是长期的负担，需要更多的关注，以改善患者的护理。
