Sleep Quality Relation with Hemodynamic Status on AMI Patients in

ICVCU Room

Akhmad Rifai

and Syifa Mutia Desiani

Health Polytechnic of Surakarta

Keywords: Acute Myocardial Infarction (AMI), Sleep Quality, Hemodynamic, MAP, Pulse, Respiration.

Abstract: Acute Myocardial Infarction (AMI) causes clinical symptoms that are felt by the patient, some of them are

shortness of breath, pale, headache, nausea, vomiting and the most common are chest pain. The presence of

such sleep disorders may affect the patient's hemodynamics. This study was conducted with the aim of

knowing whether there is a relationship between the quality of sleep with hemodynamics in AMI patients.

The research used descriptive analytic research design with cross-sectional approach. The sample used as

many as 30 respondents, sleep quality assessment using questionnaire and hemodynamic assessment done by

observation. The correlation test that used is Spearman test. The results of this study found sleep quality with

light sleep disorder 43.3%, medium 50%, weight 6.7%. The result of statistic analytic with Spearman test

showed relationship of sleep quality with MAP with p-value 0,003, sleep quality relationship with pulse

significance(p-value) 0.0001, and relation of sleep quality with respiration significance (p-value) 0.0001.

From the value of significance between sleep quality variables and hemodynamic variables showed that there

was a correlation between sleep quality and hemodynamic status (MAP, pulse and respiration) in AMI

patients. The conclusion is that there is a correlation between the quality of sleep with hemodynamic status

(MAP, pulse, respiration) in AMI patients in ICVCU RSUD Dr.Moewardi.

1 BACKGROUND

Acute Myocardial Infarction causes clinical

symptoms that the patient feels, some of them are

dyspnea (shortness of breath), orthopnea, pale, cold

sweat, headache, nausea vomiting. Clinical

symptoms in such AMI patients will leave nursing

problem and disturbing basic human needs, such as

chest pain at rest, and sleep disturbances that can

affect the patient's hemodynamic (Smeltzer, 2002).

In addition to hemodynamic changes, AMI

patients may have other symptoms; weakness,

burnout, irregular exercise schedule, dyspnea at rest

or work (Carpenito, 2000). AMI patients will

generally experience a decrease in sleep quality and

cardiovascular status. Poor sleep quality may result in

improved patient condition, which will extend

hospital stay (Nurarif 2013). The sytem of activity or

sleeping habits of nowadays is largely ignored by

society. Like people with heart disease if the sufferer

lack of sleep time resulted in the heart will work

harder. Sleep disorders characterized by increased

incidence of chest pain, increased heart rate,

electrocardiogram changes, high blood pressure and

risk of heart disease and stroke (Potter, 2010). The

hemodynamic conditions of patients with myocardial

infarction vary as cardiac output may be reduced

slightly or maintained within normal limits, increased

heart frequency is usually not continuous unless there

is myocardial depression, blood pressure is a function

of interaction between myocardial depression and

autonomic reflex (Muttaqin, 2009).

AMI patients experience hemodynamic changes

requiring intensive care in hospitals. RSUD

Dr.Moewardi Surakarta has a special room to handle

heart disease problem that is Intensive Cardio

Vascular Unit (ICVCU) room. ICVCU is a special

care unit for treating life-threatening cardiovascular

system patients with trained personnel and supported

with the completeness of specialized equipment

Based on a preliminary study conducted by

researchers at RSUD Dr.Moewardi Surakarta

obtained prevalence data of AMI patients in ICVCU

Room in 2010-2011 as many as 183 patients, in 2012

as many as 175 patients, while the year 2013-2014

increased to 825 patients. From 28 November 2015 to

9 December 2015 there are 20 cases of patients with

AMI (Medical Record, 2015). From the results of

Rifai, A. and Desiani, S.

Sleep Quality Relation with Hemodynamic Status on AMI Patients in ICVCU Room.

DOI: 10.5220/0008331407030706

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 703-706

ISBN: 978-989-758-336-0

703

interviews with 20 patients data obtained patients

complained of chest pain and there is sleep

disturbance. 25% of patients awaken from sleep

during the night due to cold, pain and not feel

comfortable during sleep. And 25% of other patients

say they can not sleep because they feel pain. Patients

with AMI who experience sleep disturbances usually

experience hemodynamic changes characterized by

blood pressure may be normal or ups and down, pulse

can be normal or up and down, increased respiratory

frequency, shortness of breath, pale and even

cyanosis (Doengoes, 2000).

The general objective of this study was to prove

the relationship between sleep quality and

hemodynamic status in AMI patients in the ICVCU

RSUD Dr.Moewardi.

2 METHODS

The type of this research is non-experimental research

with analytical descriptive and cross-sectional

approach. Data collection in this study was conducted

by providing questionnaires, observation and

documentation study that aims to analyze the

independent variables and dependent variables.

Implementation of sampling technique in this study

using nonprobability sampling method by total

sampling of 30 respondents. By using Spearman

correlation test.

3 RESULTS

3.1 Characteristics of Respondents by

Age

3.2 Characteristics of Respondents by

Sex

3.3 Distribution of Frequency based on

Sleep Quality

Table 3: Frequency Distri.bution Based on Sleep Quality.

Sleep Quality Amount Percentage(%)

no sleep disturbance

light sleep disorder

medium sleep disorder

severe sleep disorder

43.3

50.0

6.7

Total 30 100

3.4 Spearman Test between Sleep

Quality and MAP

Table 4: Spearman test between sleep quality and MAP.

N R p-value Evidence

30 0.517 0.003 There is a

relation

3.5 Spearman Test between Sleep

Quality and Pulse

Table 5: Spearman test between sleep quality and pulse.

-value Evidence

30 0.660 0.0001 There is a

relation

3.6 Spearman Test between Sleep

Quality with Respiration

Table 6: Spearman test between sleep quality and

Respiration.

NRp-value Evidence

30 0.760 0.0001 There is a relation

4 DISCUSSION

The most aged AMI respondents among 40-60 years

was 66.7%. So from the results of the study concluded

that AMI sufferers more attack at the age of 40-60

years. This is consistent with the theory of Corwin

(2009) which states that 45% AMI occurs at age >40

years and above are likely influenced by several

factors such as stress, obesity, hypertension which

causes increased afterload which will directly

increase the workload of the heart so that trigger

Table 1: Age-Based Frequency Distribution.

e Amount Percenta

(

)

< 40 years

40-60 years

>60 years

3.3

66.7

30.0

Total 30 100

Table 2: Frequency Distributions by Sex.

Gender Amount Percentage (%)

Male

Female

66.7

33.3

Total 30 100

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

704

ventricular hypertrophy left which results in an

imbalance between the need and supply of oxygen.

AMI patients who experience acute pain are

caused by hypoxia in the heart muscle tissue that

forces cells to perform anaerobic metabolism,

resulting in lactic acid and also stimulate the release

of other iriatif substances such as histamine, quinine

or cellular proteolytic enzymes that stimulate the ends

of muscle pain receptors heart and impulse pain are

transmitted through afferent nerve fibers and are

precipitated by pain due to excessive sympathetic

nervous stimulation will lead to increased cardiac

work by stimulating the SA node resulting in more

than normal or fast heart beat frequency (Corwin,

2009).

The majority of AMI patients were male. Men are

more likely to have bad habits or lifestyles that can

affect the health such as smoking and drinking

alcohol that can affect a person's health.

In a person who smokes, cigarette smoke will

damage the walls of blood vessels. Cigarettes contain

many thousands of chemicals that are harmful to the

health of the body that can cause the heart will pump

even stronger and cause increased blood pressure.

Factors that affect the heart rate are physical

exercise, temperature, emotion medicine, posture

changes and pulmonary disorders. In addition to these

factors from the study also showed that the quality of

sleep also affects the heart rate. This is because a

person who is lack of sleep will increase RAS

(Reticular Activing System), when RAS increases

one's emotions also increases finally hormone

stimulates heart and heart contractions eventually

work faster and lead to increased pulse (Potter, 2010).

Respiration of respondents >20x/min is caused by

the increasing of body oxygen requirement, while

body oxygen is not increased so that it will cause the

increase of oxygen requirement to fulfill the

requirement of body metabolism so that there will be

increasing of breathing frequency along with the

increase of pulse frequency (Potter, 2010).

In patients with heart disease such as AMI patients

usually feel the pain especially the patient with the

first attack, other than that usually patients feel

shortness of breath because the circulation of oxygen

in the blood is reduced. Lack of oxygen supply which

can cause tissue hypoxia and cause shortness of

breath. Shortness of breath in AMI patients will

usually cause sleep disorders.

MAP is the mean arterial pressure during one

heart cycle is affected by cardiac output (CO), tone,

arterial elasticity and peripheral resistance, blood

viscosity and blood pressure preservation mechanism

(Smeltzer, 2002).

The adequate of blood pressure in each individual

should always be assessed. Increased or decreased

blood pressure is strongly influenced by the sensory

nerve where the nerve can affect vasomotor activity,

especially related to pain. Light pain can increase

vasomotor activity resulting in an increase in blood

pressure, while severe pain can decrease vasomotor

activity and cause a decrease in blood pressure

(Jevon, 2009).

5 CONCLUSIONS

Most of IMA patients with age between 40-60 years.

Respondents of male sex more than women. Most

have medium sleep disorder and light sleep disorder.

There is a relationship between sleep quality and

MAP. There is a relationship between sleep quality

and pulse. There is a relationship between sleep

quality and respiration

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