The purpose of this pilot study is to explore relationships between anginal pain, sleep disturbance, and quality of life in coronary artery disease (CAD) patients, focusing on differences in symptom perceptions according to gender and status on the CAD illness trajectory. The Symptom Interactional Framework of sleep alterations and pain will serve as the theoretical base for the study. The study will have a prospective design and will be conducted in the outpatient cardiac catheterization laboratory of Emory Clinic, Emory University. Inclusion criteria include adults of any age, gender, and ethnicity who (a) are able to speak English, (b) have received a new diagnosis of CAD following elective coronary angiography or have received elective coronary angiography to evaluate status of known CAD, and (c) have a history of angina. In order to adequately address the research questions posed, the sample will be stratified by gender and by status on the CAD illness trajectory so that an equal number of males/females and newly diagnosed CAD patients on the CAD illness trajectory so that an equal number of males/females and newly diagnosed CAD patients in patients with a previous history of CAD will be represented in the analyses. A sample size of 84 subjects is proposed. Because effect size estimation is difficult (because difference between newly diagnosed CAD patients and those with a history of CAD have rarely been compared on the proposed study variables), the standard convention of a medium effect size with two- tailed alpha of .05 and a power of .80 was used to calculate sample size. Established data collection instruments will include the Chest Discomfort Diary, the Rose Questionnaire, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the Maastricht Questionnaire. Subjects will answer questions regarding chest pain, sleep disturbances, and vital exhaustion within eight hours following coronary angiography. Initial data analysis will include descriptive statistics on sample characteristics, examination for type and extent of any missing data, and assessment of psychometric properties for all study instruments. Independent samples t- tests and Pearson product moment correlations will be used to answer the three research questions. It is likely that more extensive modeling including logistic regression and/or discriminant analysis will be done for the third research question. While the study of sleep disturbances and angina is now a new area of inquiry, the proposed project has the potential to contribute to the literature by including strong conceptualization and measurement of anginal pain and sleep disturbances.
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