Investigating the Physical, Psychological, and Situational Factors Affecting Subjective Sleep Quality After Lung Transplantation

Background. Poor sleep impacts health and may be associated with emotional and physical illness. Significant gaps exist in our understanding of poor sleep quality (SQ) after lung transplantation.

Purpose. The purpose of this study, guided by an adaptation of the Theory of Unpleasant Symptoms, was to characterize the nature of subjective SQ after lung transplantation; to determine which patient physiological, psychological, and situational factors are associated with poor sleep quality in lung transplant recipients; and to examine whether poor sleep impacted mental and/or physical components of health-related quality of life (HRQoL).

Methods. In this cross-sectional, single center cohort study, 158 lung transplant recipients were invited to complete an anonymous REDCap survey. SQ was measured with the Pittsburgh Sleep Quality Index (PSQI) with scores dichotomized to poor versus good sleepers based on PSQI cutoff > 8. Additional self-report data on potential factors for poor SQ included demographic and transplant related information; co-morbidities; anxiety and depression assessed with the Hospital Anxiety (A) and Depression (D) Scale (HADS); stressors of hospitalization, treatment of rejection, and illness of family members in the preceding 30 days. HRQoL was measured with the Short Form-12 (SF-12) with its mental and physical component scores (MCS and PCS). All data analysis was performed using SPSS 28.0. The data analysis was conducted in three phases: descriptive statistics, bivariate, and multivariate analyses. Relationships between variables were examined with either chi-square analysis, Pearson’s r zero-correlations, independent-samples t-test or a One-Way ANOVA. Multivariate analyses included binary logistic and multiple linear regressions to model dependent variables as a function of the factors significantly related to that dependent variable in bivariate analysis.

Results. Survey response rate was 38.4% (61/158) and 52.5% of the sample (32/61) evidenced poor sleep. On the bivariate level, poor SQ was significantly related to symptoms of depression (p < .01); anxiety (p < .01) and stressors of hospitalization (p < .05), and treatment of acute rejection (p < .05). On the multivariate level, only anxiety predicted likelihood of poor sleep (OR = 1.34, p < .05). Mental component of HRQoL was significantly related to poor SQ on the bivariate level with lower SF-12 MCS scores among participants with poor SQ (M = 49.43) relative to those without (M = 56.21) (p < .01). However, Poor SQ was not significantly related to mental or physical components of HRQoL at the multivariate level.

Conclusion. Poor subjective SQ remains prevalent yet under-studied health problem after lung transplantation. Recipients who have symptoms of anxiety are at a greater risk for poor sleep. Poor SQ was associated with lower SF-12 MCS of HRQoL on the bivariate level but was not significantly related to the mental or physical components of HRQoL at the multivariate level. Further research is needed with standardized measures, larger cohorts, and longitudinal studies to improve understanding of poor sleep, its related factors, and its impact on HRQoL to optimize health and outcomes after lung transplant. Better understanding of the effect of these factors may guide future interventions especially for those at higher risk for poor sleep.