# Associations of perioperative depression with sleep quality and physical activity levels in patients undergoing elective cardiac surgery: A prospective observational study

## TL;DR

This study found that depression in patients before and after heart surgery is linked to poor sleep and low physical activity.

## Contribution

The study is one of the first to prospectively examine depression in cardiac surgery patients and its links to sleep and activity.

## Key findings

- Depression rates increased after surgery, peaking at day 7.
- Poor sleep and low physical activity were strongly linked to depression.
- Risk factors included age, employment, and heart function.

## Abstract

Perioperative depression is very common in patients undergoing surgery, especially major surgeries. Previous studies have shown that perioperative depression could have a negative impact on postoperative recovery and quality of life. However, few papers have focused on the depressive characteristics of patients undergoing cardiac surgeries. Therefore, the objective of this study was to prospectively investigate the incidence of depression and its associations with sleep quality and physical activity levels in patients undergoing cardiac surgeries.

A total of 100 consecutive cardiac surgery patients were prospectively enrolled in the study. Perioperative depression was measured using the Patient Health Questionnaire-9 (PHQ-9). Sleep quality and physical activity levels were assessed using the Athens Insomnia Scale (AIS) questionnaire and the International Physical Activity Questionnaire-Short Form (IPQA-SF), respectively. All the data were collected and recorded preoperatively and at postoperative days 7 and 30. Independent-samples t tests and Spearman correlation analysis were used to explore the associations of depression status with sleep quality and physical activity levels. Both univariable and multivariable logistic regression were used to detect the risk factors for depression.

The incidence of depression increased from the preoperative level (34%, 0.27–0.46), peaked at postoperative day 7 (51%, 0.41–0.61) and slightly decreased to (47%, 0.38–0.57) at postoperative day 30. Significantly higher preoperative AIS scores were found in patients with depression than in nondepressed patients (8.00 ± 1.39 vs. 5.32 ± 1.99, p < 0.001). Moreover, patients with depression had significantly lower preoperative IPAQ-SF scores than did those without depression (948.32 ± 332.57 vs. 1461.65 ± 380.59, p < 0.001). Spearman correlation analysis indicated that preoperative depression scores were strongly correlated with AIS scores (r = 0.64, p < 0.001) and moderately correlated with IPAQ-SF scores (r = −0.44, p < 0.001). Risk factors for preoperative depression were age, employment status, education level, NYHA class, AIS and IPAQ-SF scores.

Our study suggests significant associations of perioperative depression with sleep quality and physical activity levels in patients undergoing elective cardiac surgery. Patients with better sleep quality and higher levels of physical activity were significantly less likely to experience depression during the perioperative period.

This trial was registered on November 29, 2024, in the Chinese Clinical Trial Registry (ChiCTR2400093150).