Ameliyat Sonrası Dönemde Uykusuzluğun Yönetiminde Işık ile İlgili Yapılan Girişimlerin Gözden Geçirilmesi

Hastalarda, ameliyat sonrası dönemde, anksiyete, cerrahi infalamatuvar yanıt, genel anestezi, ağrı, klinik ortamdaki gürültü ve ışık gibi çevresel nedenlere bağlı olarak uykusuzluk görülebilmektedir. Uykusuzluk iyi yönetilemezse hastaların ameliyat sonrası iyileşme süreci olumsuz etkilenebilmektedir. Bu nedenle ameliyat sonrası dönemde uykusuzluğun yönetimi önemlidir. Uykusuzluğun yönetiminde ise farmakolojik yöntemler sınırlı olup gevşeme teknikleri, müzik, aromaterapi, kulak tıkacı, göz maskesi kullanımı, gürültünün azaltılması, psikolojik destek ve eğitim stratejileri gibi nonfarmakolojik yöntemlerden yararlanılması önerilmektedir.Bununla birlikte ameliyat sonrası dönemde sağlıklı bir uyku için sirkadiyen ritmin korunması önemlidir ve ışık faktörü, sirkadiyen ritmin korunmasında en önemli faktörlerden birisidir. Bu derlemenin amacı ameliyat sonrası dönemde uykusuzluğun yönetiminde göz maskesi kullanımı, sabah parlak ışık uygulaması ve hasta odasının sirkadiyen ritme uygun aydınlatılmasına yönelik ışık ile ilgili yapılan araştırmaların gözden geçirilmesi amaçlanmıştır. Yapılan gözden geçirme sonucunda, göz maskesi kullanımı, parlak ışık uygulaması, sirkadiyen ritme göre hasta odası aydınlatmalarına yönelik girişimlerin postoperatif dönemde uykusuzluğun yönetiminde faydalı olabileceğine ilişkin araştırmaların bulunduğu ancak bu alana yönelik kapsamlı araştırmaların yapılması gerektiği sonucuna varılmıştır.

Anahtar Kelimeler:

Ameliyat Sonrası Dönem, Işık, Uykusuzluk

A Review of Light-Related Interventions in the Management of Insomnia in the Postoperative Period

Patients may experience insomnia in the postoperative period due to anxiety, surgical inflammatory response, general anesthesia, pain, and environmental factors such as noise and light in the clinical environment. If insomnia is not managed well, the postoperative recovery process of patients may be negatively affected. Therefore, the management of insomnia in the postoperative period is important.In the management of insomnia, pharmacological methods are limited and it is recommended to use non-pharmacological approaches such as relaxation techniques, music, aromatherapy, use of earplugs, eye masks, noise reduction, psychological support, and educational strategies. However, it is essential to maintain circadian rhythm for a healthy sleep in the postoperative period and light is one of the most important factors in maintaining circadian rhythm. The aim of this paper is to review the studies on the use of eye masks in the management of insomnia in the postoperative period, the application of bright light in the morning, and the lighting of the patient room in accordance with the circadian rhythm. As a result of the review, it was concluded that the use of eye masks, bright light application, and interventions for patient room lighting according to circadian rhythm may be beneficial in the management of insomnia in the postoperative period. Still, comprehensive studies should be conducted in this field.

Keywords:

Insomnia, Light, Postoperative Period,

PDF

___

Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. Sleep 2015;38(8):1161-83. doi:10.5665/sleep.4886.
Hou H, Wu S, Qiu Y, Song F, Deng L. The effects of morning/afternoon surgeries on the early postoperative sleep quality of patients undergoing general anesthesia. BMC anesthesiology 2022; 22(1):1-8. doi: 10.1186/s12871-022-01828-w.
Wang Y, Liu Y, Li X, Lv Q, Xia Q, Wang X, Shao Y. Prospective assessment and risk factors of sleep disturbances in total hip and knee arthroplasty based on an Enhanced Recovery After Surgery concept. Sleep Breath. 2021;25(3):1231-1237. doi:10.1007/s11325-020-02213-y.
Long G, Suqin S, Hu Z, Yan Z, Huixin Y, Tianwang L, et al. Analysis of patients’ sleep disorder after total knee arthroplasty-A retrospective study. Journal of Orthopaedic Science. 2019;24(1):116-20. doi:10.1016/j.jos.2018.07.019
Ayuse T, Kurata S, Mishima G, Tachi M, Suzue E, Kiriishi K, et al. Influence of general anesthesia on the postoperative sleep cycle in patients undergoing surgery and dental treatment: a scoping review on the incidence of postoperative sleep disturbance. J Dent Anesth Pain Med. 2023;23(2):59-67. doi:10.17245/jdapm.2023.23.2.59.
Haack M, Simpson N, Sethna N, Kaur S, Mullington J. Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology 2020; 45(1):205-16. doi: 10.1038/s41386-019-0439-z.
Rampes S, Ma K, Divecha YA, Alam A, Ma D. Postoperative sleep disorders and their potential impacts on surgical outcomes. Journal of biomedical research 2020;4(4):271. doi: 10.7555/JBR.33.20190054.
Luo ZY, Li LL, Wang D, Wang HY, Pei FX, Zhou ZK. Preoperative sleep quality affects postoperative pain and function after total joint arthroplasty: a prospective cohort study. Journal of orthopaedic surgery and research 2019;14(1):1-0. doi: 10.1186/s13018-019-1446-9.
Varallo G, Giusti EM, Manna C, Castelnuovo G, Pizza F, Franceschini C, et al. Sleep disturbances and sleep disorders as risk factors for chronic postsurgical pain: a systematic review and meta-analysis. Sleep Medicine Reviews 2022;63:101630. doi: 10.1016/j.smrv.2022.101630.
Petrie K, Matzkin E. Can pharmacological and non-pharmacological sleep aids reduce post-operative pain and opioid usage? A review of the literature. Orthop Rev (Pavia). 2019;11(4):8306. doi:10.4081/or.2019.8306.
Dianatkhah M, Ghaeli P, Talasaz AH, Karimi A, Salehiomran A, Bina P, et al. Evaluating the potential effect of melatonin on the post-cardiac surgery sleep disorder. J Tehran Heart Cent 2015;10(3):122-8.
Hu RF, Jiang XY, Chen J, Zeng Z, Chen XY, Li Y, et al. Non-pharmacological interventions for sleep promotion in the intensive care unit. Cochrane Database Syst Rev. 2015(10):CD008808. doi: 10.1002/14651858.
Hwang E, Shin S The effects of aromatherapy on sleep improvement: a systematic literature review and meta-analysis. J Altern Complement Med 2015;21(2):61–68. doi: 10.1089/acm.2014.0113.
Scarpa M, Pinto E, Saraceni E, Cavallin F, Parotto M, Alfieri R, et al. QOLEC Group. Randomized clinical trial of psychological support and sleep adjuvant measures for postoperative sleep disturbance in patients undergoing oesophagectomy. Br J Surg. 2017;104(10):1307-1314. doi: 10.1002/bjs.10609.
Machado FS, Souza RCDS, Poveda VB, Costa ALS. Non-pharmacological interventions to promote the sleep of patients after cardiac surgery: a systematic review. Rev Lat Am Enfermagem. 2017;25:e2926. doi: 10.1590/1518-8345.1917.2926.
Duru P, Örsal Ö, Şara Y, Köşgeroğlu N. Effects of music assisted progressive relaxation exercises on postoperative sleep quality and pain ıntensity: a quasi-experimental controlled study. Journal of Turkish Sleep Medicine, 2022;9(3):244-253. doi:10.4274/jtsm.galenos.2022.75046.
Caddick ZA, Gregory K, Arsintescu L, Flynn-Evans EE. A review of the environmental parameters necessary for an optimal sleep environment. Building and environment 2018;132:11-20. doi:10.1016/j.buildenv.2018.01.020.
Chellappa SL, Steiner R, Oelhafen P, Lang D, Götz T, Krebs J, et al. Acute exposure to evening blue‐enriched light impacts on human sleep. J Sleep Res 2013 Oct;22(5):573-80. doi: 10.1111/jsr.12050.
Mason IC, Grimaldi D, Reid KJ, Warlick CD, Malkani RG, et al. Light exposure during sleep impairs cardiometabolic function. Proceedings of the National Academy of Sciences 2022;119(12):e2113290119.
Faulkner SM, Bee PE, Meyer N, Dijk DJ, Drake RJ. Light therapies to improve sleep in intrinsic circadian rhythm sleep disorders and neuro-psychiatric illness: A systematic review and meta-analysis. Sleep Med Rev. 2019; 46:108-123. doi: 10.1016/j.smrv.2019.04.012.
Fang CS, Wang HH, Wang RH, Chou FH, Chang SL, Fang CJ. Effect of earplugs and eye masks on the sleep quality of intensive care unit patients: A systematic review and meta-analysis. J Adv Nurs 2021;77(11):4321-4331. doi: 10.1111/jan.14914.
Mahran GSK, Abd-elshafy SK, Abd El-ghnyAbd El-hmeed N, Ibrahim Abdel-WahabIbrahim A, Gamaleldeenabd-elhafez N, KadeesMarzouk H. The effect of night light on delirium occurrence in post-operative cardiac patients. J Nurs Health Sci 2018; 7(1): 1- 7.
Mahran GS, Leach MJ, Abbas MS, Abbas AM, Ghoneim AM. Effect of eye masks on pain and sleep quality in patients undergoing cardiac surgery: a randomized controlled trial. Crit Care Nurse 2020; 40(1): 27- 35. doi:10.4037/ccn2020709
da Silva Higa KT, Böhme FAF, Paschoa S, Conte ACR, Santos VB, Avelar AFM. Dark nighttime interventions and sleep quality in intensive care unit patients: A systematic review and meta‐analysis. Nursing in Critical Care 2022: 1-12. doi:10.1111/nicc.12827.
Van Maanen A, Meijer AM, van der Heijden KB, Oort FJ. The effects of light therapy on sleep problems: a systematic review and meta-analysis. Sleep Med Rev. 2016;29:52-62. doi: 10.1016/j.smrv.2015.08.009
Locihová H, Axmann K, Padyšáková H, Fejfar J. Effect of the use of earplugs and eye mask on the quality of sleep in intensive care patients: a systematic review. J Sleep Res. 2018 Jun;27(3):e12607. doi: 10.1111/jsr.12607.
Hu RF, Jiang XY, Hegadoren KM, Zhang YH. Effects of earplugs and eye masks combined with relaxing music on sleep, melatonin and cortisol levels in ICU patients: a randomized controlled trial. Crit Care 2015;19(1):115. doi: 10.1186/s13054-015-0855-3.
Chang AM, Santhi N, St Hilaire M, Gronfier C, Bradstreet DS, Duffy JF, Lockley SW, Kronauer RE, Czeisler CA. Human responses to bright light of different durations. J Physiol 2012; 590(13):3103-12. doi:10.1113/jphysiol.2011.226555.
Taguchi T, Yano M, Kido Y. Influence of bright light therapy on postoperative patients: a pilot study. Intensive Crit Care Nurs 2007;23(5):289-97. doi:10.1016/j.iccn.2007.04.004.
Tan JSI, Cheng LJ, Chan EY, Lau Y, Lau ST. Light therapy for sleep disturbances in older adults with dementia: a systematic review, meta-analysis and meta-regression. Sleep Med 2022; 90:153-166. doi: 10.1016/j.sleep.2022.01.013.
Ono H, Taguchi T, Kido Y, Fujino Y, Doki Y. The usefulness of bright light therapy for patients after oesophagectomy. Intensive Crit Care Nurs 2011;27(3):158-66. doi: 10.1016/j.iccn.2011.03.003.
Potharajaroen S, Tangwongchai S, Tayjasanant T, Thawitsri T, Anderson G, Maes M. Bright light and oxygen therapies decrease delirium risk in critically ill surgical patients by targeting sleep and acid-base disturbances. Psychiatry Res. 2018;261:21-27. doi:10.1016/j.psychres.2017.12.046.
Lu Y, Li YW, Wang L, Lydic R, Baghdoyan HA, Shi XY, Zhang H. Promoting sleep and circadian health may prevent postoperative delirium: a systematic review and meta-analysis of randomized clinical trials. Sleep medicine reviews 2019;48:101207. doi: 10.1016/j.smrv.2019.08.001.
Anitha Vijayalakshmi B, Nesasudha M. Transferring patient’s biomedical information using illumination and communication technology under dim lighting in hospitals. Optical and Quantum Electronics 2020;52:1-0. doi:10.1007/s11082-020-02340-6
Ferrante T, Villani T. Pre-occupancy evaluation in hospital rooms for efficient use of natural light—ımproved proposals. Buildings. 2022;12(12):2145. doi:10.3390/buildings12122145.
Acosta I, Leslie R, Figueiro M. Analysis of circadian stimulus allowed by daylighting in hospital rooms. Lighting Research & Technology 2017;49(1):49-61. doi:10.1177/1477153515592948.
Iwamoto J, Obayashi K, Kobayashi M, Kotsuji T, Matsui R, Ito K, et al. Decreased daytime light intensity at nonwindow hospital beds: Comparisons with light intensity at window hospital beds and light exposure in nonhospitalized elderly individuals. Chronobiol Int. 2018;35(5):719-723. doi:10.1080/07420528.2018.1430036.
McCunn LJ, Safranek S, Wilkerson A, Davis RG. Lighting control in patient rooms: understanding nurses' perceptions of hospital lighting using qualitative methods. HERD. 2021;14(2):204-218. doi:10.1177/1937586720946669.
Vethe D, Scott J, Engstrøm M, Salvesen Ø, Sand T, Olsen A, et al. The evening light environment in hospitals can be designed to produce less disruptive effects on the circadian system and improve sleep. Sleep 2021;44(3):zsaa194. doi:10.1093/sleep/zsaa194.
Bellon F, Mora-Noya V, Pastells-Peiró R, Abad-Corpa E, Gea-Sánchez M, Moreno-Casbas T. The efficacy of nursing interventions on sleep quality in hospitalized patients: A systematic review of randomized controlled trials. Int J Nurs Stud 2021;115:103855.doi: 10.1016/j.ijnurstu.2020.103855.