Analysis of sleep characteristics and clinical outcomes of 139 adult patients with infective endocarditis after surgery

doi:10.12998/wjcc.v9.i22.6319

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World Journal of Clinical Cases

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World J Clin Cases. Aug 6, 2021; 9(22): 6319-6328
Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6319

Table 1 Demographic and clinical baseline characteristics of participants (n = 139)

Variables	*Total (n =* 139)**	*Group 1 (n =* 53)**	*Group 2 (n =* 86)**	P value
Gender (male)	94 (67.6%)	39 (73.6%)	55 (64.0%)	0.239
Age (yr)	43.40 ± 14.56	40.89 ± 14.17	44.94 ± 14.66	0.111
BMI (kg/m²)	20.33 ± 3.37	20.29 ± 3.10	20.36 ± 3.55	0.919
Duration of CICU stay (d)	2.20 ± 1.50	2.09 ± 1.72	2.34 ± 1.33	0.352
Use of analgesics (cases)	33 (23.7%)	14 (26.4%)	19 (22.1%)	0.561
Use of sleep medication (cases)	47 (33.8%)	3 (5.7%)	44 (51.2%)	< 0.001^a
Preoperative WBC (× 10⁹/L)	8.34 ± 3.10	8.67 ± 2.96	8.14 ± 3.18	0.329
Postoperative WBC (× 10⁹/L)	18.68 ± 7.79	18.77 ± 7.79	18.62 ± 7.84	0.914
Preoperative Hb (g/L)	110.10 ± 23.34	108.26 ± 23.67	111.23 ± 23.21	0.468
Postoperative Hb (g/L)	100.86 ± 14.61	101.02 ± 14.54	100.76 ± 14.73	0.918
Preoperative Alb (g/L)	33.80 ± 5.65	34.10 ± 5.66	33.62 ± 5.67	0.629
Postoperative Alb (g/L)	32.44 ± 4.35	33.26 ± 4.52	31.93 ± 4.20	0.081
Preoperative CRP (mg/L)	27.43 ± 33.08	30.84 ± 36.43	25.33 ± 30.87	0.342
Postoperative CRP (mg/L)	34.43 ± 29.06	36.08 ± 32.87	33.41 ± 26.61	0.601
Postoperative PCT (ng/mL)	1.10 ± 4.98	1.89 ± 7.85	0.62 ± 1.38	0.147
Vegetation ≥ 10 mm	78 (56.1%)	31 (58.5%)	47 (54.7%)	0.658
Complication of embolism	34 (24.5%)	11 (20.8%)	23 (26.7%)	0.425

Data are presented as mean and standard deviation or n (%). Comparison between the two groups was performed using the t-test and chi-square test where appropriate.

^aP < 0.05. BMI: Body mass index; CICU: Cardiac intensive care unit; WBC: White blood cell; Hb: Hemoglobin; Alb: Albumin; CRP: C-reactive protein; PCT: Procalcitonin.

Table 2 Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale scores collected during hospitalization and at 6 mo after surgery (n = 139)

Variables	During hospitalization	Post hospitalization	P value
PSQI (points)	9.0 (6.0, 12.0)	5.0 (4.0, 8.0)	< 0.001^a
PSQI ≥ 8 (cases)	86 (61.9%)	46 (33.1%)	< 0.001^a
ESS (points)	7.0 (4.0, 9.0)	5.0 (3.0, 8.0)	< 0.001^a
ESS ≥ 9 (cases)	44 (31.7%)	20 (14.4%)	0.001^a

Data were analyzed using the Wilcoxon rank-sum test or χ² test where appropriate. Data are presented as median and interquartile range (25^th and 75^th percentile) or quantity and percentage (%) where appropriate.

^aP < 0.05. PSQI: Pittsburgh Sleep Quality Index; ESS: Epworth Sleepiness Scale.

Table 3 Comparison of Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale scores at 6 mo after surgery between Group 1 (n = 53) and Group 2 (n = 86)

	*Total (n =* 139)**	*Group 1 (n =* 53)**	*Group 2 (n =* 86)**	P value
PSQI (points)	5.0 (4.0, 8.0)	3.0 (2.0, 5.0)	7.0 (5.0, 10.0)	< 0.001^a
PSQI ≥ 8 (cases)	46 (33.1%)	4 (7.5%)	42 (48.8%)	< 0.001^a
ESS (points)	5.0 (3.0, 8.0)	4.0 (3.0, 7.0)	5.5 (3.0, 8.0)	0.194
ESS ≥ 9 (cases)	20 (14.4%)	5 (9.4%)	15 (17.4%)	0.191

^aP < 0.05. PSQI: Pittsburgh Sleep Quality Index; ESS: Epworth Sleepiness Scale.

Table 4 Univariable logistic regression analysis exploring potential risk factors for disturbed sleep quality at 6 mo after surgery in the whole data set (n = 139)

Variables	B	P value	OR	95%CI
Gender (male)	0.134	0.731	1.143	0.534-2.448
Age (yr)	0.084	< 0.001¹	1.087	1.052-1.123
BMI (kg/m²)	0.056	0.294	1.058	0.952-1.175
Duration of CICU stay (d)	0.243	0.052	1.275	0.997-1.630
Preoperative WBC (× 10⁹/L)	0.019	0.749	1.019	0.909-1.141
Postoperative WBC (× 10⁹/L)	-0.004	0.870	0.996	0.952-1.043
Preoperative Hb (g/L)	0.012	0.135	1.012	0.996-1.028
Postoperative Hb (g/L)	0.008	0.499	1.008	0.984-1.033
Preoperative Alb (g/L)	0.030	0.364	1.030	0.966-1.098
Postoperative Alb (g/L)	-0.053	0.217	0.949	0.873-1.031
Preoperative CRP (mg/L)	-0.008	0.193	0.992	0.979-1.004
Postoperative CRP (mg/L)	-0.004	0.560	0.996	0.984-1.009
Postoperative PCT (ng/ml)	-0.099	0.440	0.906	0.705-1.164
Vegetation ≥ 10 mm	-0.025	0.946	0.976	0.479-1.989
Multivalve involvement	-0.971	0.126	0.379	0.109-1.315
Complication of embolism	0.225	0.600	1.252	0.540-2.902
Not using sleep medication	-0.208	0.582	0.812	0.388-1.702
PSQI during hospitalization (points)	0.464	< 0.001¹	1.590	1.359-1.860
ESS during hospitalization (points)	0.039	0.126	1.040	0.944-1.146

¹Factors that were included in the subsequent multivariable analysis. Data were analyzed in univariable logistic regression. BMI: Body mass index; CICU: Cardiac intensive care unit; WBC: White blood cell; Hb: Hemoglobin; Alb: Albumin; CRP: C-reactive protein; PCT: Procalcitonin; PSQI: Pittsburgh Sleep Quality Index; ESS: Epworth Sleepiness Scale; OR: Odds ratio; CI: Confidence interval.

Table 5 Multivariable logistic regression analysis exploring potential risk factors for disturbed sleep quality at 6 mo after surgery in the whole data set (n = 139)

Variable	B	P value	OR	95%CI
Age	0.118	< 0.001^a	1.125	1.068-1.186
Duration of CICU stay (d)	0.067	0.708	1.069	0.754-1.515
PSQI during hospitalization (points)	0.565	< 0.001^a	1.759	1.436-2.155

^aP < 0.05. Data were analyzed in multivariable logistic regression. CICU: Cardiac intensive care unit; PSQI: Pittsburgh Sleep Quality Index; OR: Odds ratio; CI: Confidence interval.

Table 6 Univariable logistic regression analysis exploring potential risk factors for disturbed sleep quality at 6 mo after surgery in Group 2 (n = 86)

Variables	B	P value	OR	95%CI
Gender (male)	0.435	0.731	1.143	0.534-2.448
Age (yr)	0.100	< 0.001¹	1.105	1.058-1.155
BMI (kg/m²)	0.077	0.221	1.080	0.955-1.222
Duration of CICU stay (d)	0.329	0.057¹	1.389	0.990-1.949
Preoperative WBC (× 10⁹/L)	0.044	0.520	1.045	0.913-1.197
Postoperative WBC (× 10⁹/L)	-0.001	0.962	0.999	0.946-1.054
Preoperative Hb (g/L)	0.010	0.288	1.010	0.992-1.029
Postoperative Hb (g/L)	0.006	0.699	1.006	0.977-1.035
Preoperative Alb (g/L)	0.035	0.362	1.036	0.960-1.118
Postoperative Alb (g/L)	-0.036	0.496	0.965	0.871-1.069
Preoperative CRP (mg/L)	-0.005	0.506	0.995	0.981-1.010
Postoperative CRP(mg/L)	-0.001	0.928	0.999	0.983-1.015
Postoperative PCT (ng/ml)	-0.014	0.929	0.986	0.724-1.343
Vegetation ≥ 10 mm	-0.009	0.984	0.991	0.424-2.318
Multivalve involvement	-0.511	0.456	0.600	0.157-2.298
Complication of embolism	0.294	0.549	1.342	0.513-3.508
Not using sleep medication	0.848	0.055¹	2.336	0.984-5.546
PSQI during hospitalization (points)	0.527	< 0.001¹	1.694	1.339-2.143
ESS during hospitalization (points)	0.025	0.673	1.025	0.914-1.149

Table 7 Multivariable logistic regression analysis exploring potential risk factors for disturbed sleep quality at 6 mo after surgery in Group 2 (n = 86)

Variable	B	P value	OR	95%CI
Age	0.160	< 0.001^a	1.174	1.085-1.270
Duration of CICU stay (d)	0.032	0.917	1.032	0.565-1.888
PSQI during hospitalization (points)	0.885	< 0.001^a	2.422	1.604-3.658
Not using sleep medication	2.766	0.004^a	15.893	2.385-105.889

^aP < 0.05. Data were analyzed in multivariable logistic regression. CICU: Cardiac intensive care unit; PSQI: Pittsburgh Sleep Quality Index; OR: Odds ratio; CI: Confidence interval.

Citation: Hu XM, Lin CD, Huang DY, Li XM, Lu F, Wei WT, Yu ZH, Liao HS, Huang F, Huang XZ, Jia FJ. Analysis of sleep characteristics and clinical outcomes of 139 adult patients with infective endocarditis after surgery. World J Clin Cases 2021; 9(22): 6319-6328
URL: https://www.wjgnet.com/2307-8960/full/v9/i22/6319.htm
DOI: https://dx.doi.org/10.12998/wjcc.v9.i22.6319