Disruptions in Sleep Health and Independent Associations with Psychological Distress in Close Family Members of Cardiac Arrest Survivors: A Prospective Study

Abstract

Background: While recent guidelines have noted the deleterious effects of poor sleep on cardiovascular health, the upstream impact of cardiac arrest-induced psychological distress on sleep health metrics among families of cardiac arrest survivors remains unknown.

Methods: Sleep health of close family members of consecutive patients with cardiac arrest admitted to an academic center (August 16, 2021-June 28, 2023) was self-reported using the Pittsburgh Sleep Quality Index (PSQI). The baseline PSQI, focused on sleep in the month before cardiac arrest, was administered during hospitalization and repeated 1 month after cardiac arrest alongside the Patient Health Questionnaire-8 (PHQ-8) to assess depression severity. Multivariable linear regressions analyzed associations between total PHQ-8 scores and changes in global PSQI scores between baseline and 1 month, with higher scores indicating deterioration. A prioritization exercise explored potential interventions categorized into the family's information and well-being needs to reduce psychological distress.

Results: In our sample of 102 close family members (mean age 52 ± 15 years, 70% female, 21% Black, 33% Hispanic), mean global PSQI scores showed a significant decline between baseline and 1 month after cardiac arrest (6.2 ± 3.8 vs. 7.4 ± 4.1; P < .01). This deterioration was notable for sleep quality, duration, and daytime dysfunction. Higher PHQ-8 scores were significantly associated with higher change in PSQI scores after adjusting for family members' age, sex, race/ethnicity, prior psychiatric history, and patient's discharge disposition (B = 0.4 [95% CI 0.24-0.48]; P < .01, β = 0.5). Most families expressed a higher priority for information-based interventions over well-being needs to help alleviate psychological distress during the first month following cardiac arrest (76% vs. 34%, P < .01).

Conclusions: A significant sleep health decline was observed among close family members of cardiac arrest survivors during the acute period, with psychological distress associated with this disruption. Understanding these temporal associations will help guide the development of targeted interventions to support families during this uncertain time.

Keywords: Cardiac arrest; anxiety; caregiver; depression; post-traumatic stress disorder; sleep.

Fig.1.

Mean PSQI subcategory scores of close family members of cardiac arrest survivors: premorbid evaluation versus 1 month post-arrest. **denotes P < .05

Fig.2.

Perceptions of helpfulness among close family members during cardiac arrest hospitalization and beyond, by intervention.

Fig.3.

Listing of 8 interventions with response counts for first, second, and third rankings by close family members.