Cardiovascular Journal of Africa: Vol 28 No 5 (September/October 2017)

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Nearly one-quarter of patients say mechanical heart valve disturbs sleep
‘For some patients, the closing sound of their mechanical heart
valve reduces their quality of life, disturbs their sleep, causes
them to avoid social situations, and leads to depression and
anxiety’, said lead author Dr Kjersti Oterhals, a nurse researcher
at Haukeland University Hospital in Bergen, Norway. He was
speaking at EuroHeartCare 2017 in Sweden.
This study investigated how the noise of a mechanical
heart valve affected patients’ lives, in particular their sleep, and
whether there were any differences between women and men.
In April 2013 all 1 045 patients who had undergone aortic
valve replacement at Haukeland University Hospital between
2000 and 2011 were invited to participate in a postal survey. Of
the 908 patients who responded, 245 had received a mechanical
valve and were included in the current analysis.
Patients were asked if the valve sound was audible to them or
others, if they sometimes felt uneasy about the sound, if the sound
disturbed them during daytime or during sleep, and whether they
wanted to replace the mechanical valve with a soundless prosthetic
valve if possible. Patients ranked the noise on a scale of 0 (does not
disturb them at all) to 10 (causes maximum stress). The Minimal
Insomnia Symptom Scale, which consists of three questions about
sleep, was used to give patients a score of 0 to 12 for insomnia.
Patients were 60 years old on average and 76% were men.
Nearly one-quarter (23%) said the valve sound disturbed them
during sleep and 9% said it disturbed them during the day. Some
28% wanted to replace their valve with a soundless prosthetic
valve if possible. Over half (51%) said the noise was often or
sometimes audible to others, but only 16% said they sometimes
felt uneasy about others hearing it.
The researchers found that 87% of men and 75% of women
said that they were able to hear the closing sound of their
mechanical valve. Women were more disturbed by the valve
sound than men.
Some 53% of the respondents had no insomnia, 31% had
subclinical insomnia, and 17% had moderate to severe insomnia.
Valve noise perception was the strongest predictor of insomnia,
followed by age and female gender. There was a linear association
between insomnia and valve noise perception, and the more
patients considered the valve noise a disturbance in daily life, the
more insomnia they reported.
Dr Oterhals said ‘Almost one-fourth of patients said that the
sound of their mechanical heart valve makes it difficult for them
to sleep. Most of us need a quiet environment when we are going
to sleep and these patients found it hard to ignore the noise from
the valve.’
Not all patients are aware before surgery that they may hear
their mechanical valve, and while most get used to it, for some it
is troublesome for many years. ‘One female patient said to me, “I
will never have silence around me again” when she realised she
would hear the noise 24 hours a day for the rest of her life’, said
Dr Oterhals.
The most common ways patients coped with the noise when
trying to sleep were to sleep on their right side, which reduced
the valve noise, put the duvet around their bodies to isolate the
sound, listen to music and do relaxation exercises. Ear plugs were
not effective and made the valve noise louder.
Dr Oterhals said: ‘We are not very proactive about this issue
at the moment. It would improve many patients’ quality of life
if we asked them about valve noise and provided advice to those
who find it distressing.’
Source: European Society of Cardiology Press Office