Anxiety and Stress Levels on Liver Transplantation Candidates.

The objective of the present study was to determine the anxiety and stress levels of liver transplant candidates during the preoperative period. A cross-sectional, prospective study was conducted on 52 liver transplantation candidates seen at a specialized public hospital outpatient clinic in the interior of the state of São Paulo, Brazil. Data were collected from November 2014 to April 2015 using a self-applicable questionnaire for the assessment of anxiety (State-Trait Anxiety Inventory, short version) and stress (Perceived Stress Scale), in addition to sociodemographic and clinic characterization. The mean (±SD) anxiety level detected was 23.06 ± 5.51 points, with 1.92% of the subjects showing minimum levels (0 to 12 points), 59.62% a medium level (12 to 24 points), 36.54% a moderate level (24 to 36 points), and 1.92% a severe level (36 to 48 points) of anxiety. The mean level on the stress scale was 12.10 ± 5.62 points, with 7.69% of the subjects showing high stress levels. When individuals with good and poor stress levels were compared, a significant difference was observed between them (P = .0004). The Spearman correlation test showed that the higher the stress, the higher the levels of anxiety (r = 0.4258), P < .0001. The present study contributes to the analysis of the mental health of liver transplantation candidates in view of the need for interventions for the improvement of anxiety and stress levels since the waiting period for the organ generates emotional changes that can affect the quality of life of the patient and the success of this complex therapeutic modality.

Sleep Quality Assessment and Daytime Sleepiness of Liver Transplantation Candidates.

OBJECTIVE: The goal of this study was to evaluate the sleep quality and daytime sleepiness of patients eligible for liver transplants. METHODS: A cross-sectional prospective study was conducted on liver transplant candidates from a transplant center in the interior of São Paulo State. The Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale questionnaires were applied to obtain demographic and clinical characteristics and to assess sleep quality and daytime sleepiness. RESULTS: The mean (±SD) score on the Epworth Sleepiness Scale of the 45 liver transplantation candidates was 7.00 ± 2.83 points, with 28.89% having scores >10 points, indicating excessive daytime sleepiness. The mean score on the Pittsburgh Sleep Quality Index was 6.64 ± 4.95 points, with 60% of the subjects showing impaired sleep quality, with scores >5 points. The average sleep duration was 07:16 h. Regarding sleep quality self-classification, 31.11% reported poor or very poor quality. It is noteworthy that 73.33% of patients had to go to the bathroom, 53.33% woke up in the middle of the night, and 40.00% reported pain related to sleeping difficulties. Comparison of subjects with good and poor sleep quality revealed a significant difference in time to sleep (P = .0002), sleep hours (P = .0003), and sleep quality self-classification (P = .000072). CONCLUSION: Liver transplant candidates have a compromised quality of sleep and excessive daytime sleepiness. In clinical practice, we recommend the evaluation and implementation of interventions aimed at improving the sleep and wakefulness cycle, contributing to a better quality of life.

Relevance of anxiety and stress levels on sleep quality after liver transplantation.

The goal of this study was to assess the effects of anxiety and stress on sleep quality in liver transplantation recipients. A prospective cross-sectional study was performed including 45 recipients enrolled at a liver transplantation program at Ribeirão Preto, State of São Paulo, Brazil. Anxiety and stress were evaluated by using a reduced version of the State-Trait Anxiety Inventory and the Perceived Stress Scale, respectively. Sleep quality and excessive daytime sleepiness were evaluated by using the Brazilian Portuguese versions of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. Thirty-two (71.11%) recipients presented with compromised sleep quality and 5 (11.11%) presented with excessive daytime sleepiness. Recipients with bad sleep quality had anxiety (mean, 26.91 points) and stress (mean, 17.88 points) levels that were higher than the levels of patients with normal sleep quality patterns, with anxiety levels presenting with statistically significant differences (P = .0420). Patients with above-average stress levels also had increased anxiety (mean, 28 points) and compromised sleep quality (mean, 7.03 points). In conclusion, a liver transplantation recipient who experiences bad sleep quality also has higher levels of anxiety and stress, suggesting a relationship between the sleep-wakefulness cycle and anxiety/stress. Planning strategies aimed at reducing such emotional shifts among recipients is of paramount importance. Therefore, new strategies focusing on improving the sleep pattern of patients are necessary because unhealthy sleep behavior may impair postoperative recovery.