Effects of Mindfulness-Based Stress Reduction Combined With Perioperative Refined Nursing on Postoperative Sleep Disturbances, Anxiety, and Depression in Patients Undergoing Coronary Artery Bypass Grafting

Abstract

Background:To assess whether integrating mindfulness-based stress reduction (MBSR) into refined perioperative nursing is associated with improvements in postoperative sleep disturbances, anxiety, and depression in patients undergoing coronary artery bypass grafting (CABG).

Methods: We retrospectively reviewed 146 CABG patients treated at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from July 2023 to August 2025. To reduce selection bias, 1:1 propensity score matching (PSM) was performed based on baseline characteristics, yielding 73 matched pairs for analysis. Based on the nursing protocol documented in the medical records, patients were classified into two groups: a standard care group had received standard refined perioperative nursing, while an MBSR group had received the same care supplemented with MBSR. Outcome measures included Hospital Anxiety and Depression Scale (HADS) scores assessed preoperatively and on postoperative day 7, objective sleep architecture indices obtained via actigraphy on the day of surgery and on postoperative day 7, length of hospital stay, time to first postoperative ambulation, incidence of sleep disturbances on postoperative day 7, and serum levels of interleukin-6 (IL-6), cortisol, orexin, and tumor necrosis factor-α (TNF-α) measured preoperatively and at 24 and 72 hours postoperatively. Statistical analyses included t-tests, repeated measures analysis of variance, and chi‑square tests.

Results: After PSM, 73 patients were included in each group, with all standardized mean differences < 0.1. Baseline preoperative HADS scores did not differ between groups (p > 0.05). On postoperative day 7, bothgroups showed reductions in (HADS-Anxiety) HADS-A and HADS-Depression (HADS-D), with the MBSR group exhibiting significantly lower scores on all HADS subscales than the standard care group (p < 0.05). PSQI scores on the day of surgery were similar (p > 0.05); On postoperative day 7, both groups improved in total PSQI and across its seven domains versus the surgical day. The MBSR group had significantly better scores than the standard care group for all PSQI domains and total score except subjective sleep quality and hypnotic use(p<0.05). Timetofirstpostopera tive ambulation was shorter and the rate of sleep disturbance on postoperative day 7 was lower in the MBSR group (p < 0.05); mean hospital stay did not differ (p > 0.05). Objective sleep parameters on the day of surgery were comparable (p > 0.05); on postoperative day 7 both groups showed increased total sleep time and sleep efficiency, with greater gains in the MBSR group (p < 0.05). Nighttime awakenings decreased in both groups, with the MBSR group showing a larger reduction (p < 0.05). Repeated-measures analysis of variance (ANOVA) revealed significant effects of time, group, and time-by-group interaction for cortisol, orexin, IL-6, and TNF-α (p < 0.05). Within-group analyses showed postoperative increases in cortisol, IL-6, and TNF-α at 24 and 72 hours and declines in orexin versus baseline (p < 0.05). Between-group comparisons at 24 and 72 hours postoperatively demonstrated lower cortisol, IL-6, and TNF-α and higher orexin in the MBSR group compared with the standard care group (p < 0.05), and the temporal patterns differed significantly between groups (p < 0.05).

Conclusions: Refined perioperative nursing incorporating MBSR was associated with alleviation of negative emotions in patients undergoing CABG, a lower incidence of sleep disturbances on the 7th postoperative day, and shorter time to first postoperative ambulation.