Effects of Aromatherapy on Stress Responses, Autonomic Nervous System Activity and Blood Pressure in the Patients Undergoing Coronary Angiography: A Non-Randomized Controlled Trial

Eun Jeong Song; Mi Young Lee

doi:10.4040/jkan.2018.48.1.1

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Song and Lee: Effects of Aromatherapy on Stress Responses, Autonomic Nervous System Activity and Blood Pressure in the Patients Undergoing Coronary Angiography: A Non-Randomized Controlled Trial

Original Article

J Korean Acad Nurs 2018;48(1):1-11.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.1.1

Effects of Aromatherapy on Stress Responses, Autonomic Nervous System Activity and Blood Pressure in the Patients Undergoing Coronary Angiography: A Non-Randomized Controlled Trial

Eun Jeong Song¹, Mi Young Lee^2,

¹Department of Nursing, Eulji University Hospital, Daejeon

²College of Nursing, Eulji University, Daejeon, Korea

Address reprint requests to : Lee, Mi Young College of Nursing, Eulji University, 77 Gyeryong-ro, 771beon-gil, Jung-gu, Daejeon 34824, Korea Tel: +82-42-259-1718 Fax: +82-42-259-1709 E-mail: mylee3730@eulji.ac.kr

Received 14 June 2017 Revised 18 December 2017 Accepted 23 December 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to examine the effects of aromatherapy on stress responses, autonomic nervous system (ANS) activity, and blood pressure in patients hospitalized to receive coronary angiography (CAG).

Methods

A non-equivalent control group with a pretest-posttest design was used. The subjects were patients admitted to the day angiography room to receive CAG at E University Hospital (34 in the experimental group and 30 in the control group). The experimental group treatment was inhalation of the aroma oil blended with lavender, ylang-ylang, and neroli at a ratio of 4:2:1 twice before and after CAG. The measurements of stress index, ANS activity, and blood pressure were performed 5 times as follows: at admission, at pre-CAG after treatment I, at post-CAG, 2 hours after treatment II, and 4 hours after treatment II. The data were analyzed using the Mann-Whitney U Test and repeated-measures analysis of variance.

Results

Significant interactions in the high frequency of ANS (F=5.58, p=.005) were observed between group and time. Stress index (z=2.14, p=.016), systolic blood pressure (z=4.14, p<.005), and diastolic blood pressure (z=3.28, p=.001) were significantly different between the experimental and control groups after 4 hours of treatment II.

Conclusion

The findings showed that aromatherapy was not effective before CAG, but was effective after CAG. Therefore, aromatherapy can be used as a nursing intervention for patients receiving CAG.

Keywords: Aromatherapy, Blood pressure, Coronary angiography, Autonomic nervous system

References

1. Statistics Korea. 2015 cause of death in Korea [Internet]. Daejeon: Statistics Korea;c2016. [cited 2016 Sep 27]. Available from:. http://kostat.go.kr/portal/korea/kor_nw/2/6/2/index.board?bmode=read&aSeq=356345.

2. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison’s principles of internal medicine. 16th ed. New York: McGraw-Hill;2005. p. 1277–1278. 1410-1413.

3. Park AR, Choi JY. Factors predicting patient discomfort after coronary angiography. Journal of Korean Academy Nursing. 2009; 39(6):860–867. https://doi.org/10.4040/jkan.2009.39.6.860.

4. Ann SR, Suzanne MT, Paulena N. Family life management. 6th ed. New York: Macmillan;1986. p. 269–307.

5. Lee HS, Hwang HS, Kim YA. Effects of hand massage with aroma oil on stress responses and serum immunity of registered nurse during the night duty. Journal of Korean Academic Society of Nursing Education. 2007; 13(2):169–176.

6. Jamshidi N, Abbaszadeh A, Kalyani MN, Sharif F. Effectiveness of video information on coronary angiography patients’ outcomes. Collegian. 2013; 20(3):153–9. https://doi.org/10.1016/j.colegn.2012.06.001.

7. Kang MS, Park KM, Park CJ. Deducing coronary artery disease anxiety through musical therapy and providing information. Journal of Korean Academy of Nursing. 2000; 30(2):380–390. https://doi.org/10.4040/jkan.2000.30.2.380.

8. Lee HY, Kim SY. The trends of nursing research on aromatherapy in Korea. Journal of East-West Nursing Research. 2010; 16(2):85–95.

9. Homeyra T, Ghahraman M, Vahid M, Soghra H, Homeyra A, Niloofar R. The impact of aromatherapy on the anxiety of patients experiencing coronary angiography. Zahedan Journal of Research in Medical Sciences. 2012; 14(3):51–55.

10. Tahmasebi H, Abbasi E, Zafari M, Darvishi H. The impact of aromatherapy on hemodynamic condition of patients experiencing coronary angiography. Medical Surgical Nursing Journal. 2013; 2(1-2):26–32.

11. Karadag E, Samancioglu S, Ozden D, Bakir E. Effects of aromatherapy on sleep quality and anxiety of patients. Nursing in Critical Care. 2017; 22(2):105–112. https://doi.org/10.1111/nicc.12198.

12. Shiina Y, Funabashi N, Lee KH, Toyoda T, Sekine T, Honjo S, et al. Relaxation effects of lavender aromatherapy improve coronary flow velocity in healthy men evaluated by transthoracic Doppler echocardiography. International Journal of Cardiology. 2008; 129(2):193–197. https://doi.org/10.1016/j.ijcard.2007.06.064.

13. Nomura S, Maeyama K, Ito K. Enhancement of autonomic stress response and reduction of subjective stress by lavender inhalation during a short-term calculation task. Advanced Biomedical Engineering. 2016; 5:7–12. https://doi.org/10.14326/abe.5.7.

14. Salvatore B. The complete guide to aromatherapy. 2nd ed. Brisbane: International Centre of Holistic Aromatherapy;2003. p. 236–279. 409.

15. Mahmood RN, Javad B, Mahdi BM, Hossein A. Effect of aromatherapy on anxiety in patients with acute coronary syndrome hospitalized in cardiac care unit. Bali Medical Journal. 2017; 6(2):331–336. https://doi.org/10.15562/bmj.v6i2.385.

16. Choi JY, Oh HK, Chun KK, Lee JS, Park DK, Choi SD, et al. A study for antistress effects of two aromatic synergic blending oils. Annals of Clinical Neurophysiology. 2000; 2(2):70–80.

17. Cho MY, Min ES, Hur MH, Lee MS. Effects of aromatherapy on the anxiety, vital signs, and sleep quality of percutaneous coronary intervention patients in intensive care units. Evidence-Based Complementary and Alternative Medicine. 2013; 2013:381381. https://doi.org/10.1155/2013/381381.

18. Kim HY, Lee S. Effects of aromatherapy on anxiety and sleep of inpatients with coronary angiography. Journal of People Plants and Environment. 2014; 17(6):457–463.

19. Jennine S. The autonomic nervous system and aromatherapy: A therapist’s guide to working with the two systems. New Westminster: International Essential Oil Corporation;1998. p. 2–10.

20. Bae JM, Park GH. An illustrated guide to medical statistics using SPSS. Seoul: Hannarae Publishing Co.;2012. p. 1–367.

21. Lim SU, Park HJ. The effects of aroma inhalation therapy on stress, anxiety and depression in coronary care unit patients. Journal of Korea Contents Association. 2016; 16(3):1–10. https://doi.org/10.5392/JKCA.2016.16.03.001.

22. Muzzarelli L, Force M, Sebold M. Aromatherapy and reducing preprocedural anxiety: A controlled prospective study. Gastroenterology Nursing. 2006; 29(6):466–471.

23. Peng SM, Koo M, Yu ZR. Effects of music and essential oil inhalation on cardiac autonomic balance in healthy indi- viduals. Journal of Alternative & Complementary Medicine. 2009; 15(1):53–57. https://doi.org/10.1089/acm.2008.0243.

24. Bae IL, Hur MH. The effects of essential oil inhalation on the stress and sympathetic nerve activity. The Korean Journal of Stress Research. 2016; 24(2):75–83. https://doi.org/10.17547/kjsr.2016.24.2.75.

25. Shin YS, Cho YS, Jung YJ. The effects of aromatherapy on autonomic nerve system and physical resistance of a stress. Journal of Korean Biological Nursing Science. 2004; 6(2):5–17.

26. Kim IH, Kim C, Seong K, Hur MH, Lim HM, Lee MS. Essential oil inhalation on blood pressure and salivary cortisol levels in prehypertensive and hypertensive subjects. Evidence-Based Complementary and Alternative Medicine. 2012; 2012:984203. https://doi.org/10.1155/2012/984203.

27. Hwang JH. The effects of the inhalation method using essential oils on blood pressure and stress responses of clients with essential hypertension. Journal of Korean Academy of Nursing. 2006; 36(7):1123–1134. https://doi.org/10.4040/jkan.2006.36.7.1123.

Figure 1.

Research design.

Figure 2.

Flow diagram of the study.

Table 1.

Homogeneity of General Characteristics and Dependent Variables between Groups (N=64)

Characteristics	Categories	Exp. (n=34)	Cont. (n=30)	χ²/t/z R)	p
		M±SD/n (%)/Median (IQR)	M±SD/n (%)/Median (IQR
Gender	Male	19 (55.9)	21 (70.0)	1.36	.244
	Female	15 (44.1)	9 (30.0)
Age (yr)		62.26±11.09	58.57±9.38	−1.43	.158
Education	Junior college	10 (29.5)	9 (30.0)	6.66	.155
	High school	6 (17.6)	8 (26.7)
	Middle school	12 (35.3)	3 (10.0)
	Elementary school or below	6 (17.6)	10 (33.3)
Economic level	High	1 (2.9)	0 (0.0)	2.55^†	.261
	Middle	31 (91.3)	25 (83.3)
	Low	21 (5.8)	5 (16.7)
Allergic disease	Yes	0 (0.0)	0 (0.0)	−	−
	No	34 (100.0)	30 (100.0)
Inspection	Symptoms	24 (70.6)	21 (70.0)	0.99^†	.600
	Medical check up	3 (8.8)	1 (3.3)
	Follow up	7 (20.6)	8 (26.7)
Anxiety	Pain	1 (2.9)	3 (10.0)	2.98^†	.385
	Bad result	29 (85.3)	21 (70.0)
	Family history	1 (2.9)	3 (10.0)
	Long time	3 (8.8)	3 (10.0)
Smoking	Yes	6 (17.6)	7 (23.3)	0.32	.573
	No	28 (82.4)	23 (76.7)
Alcohol drinking	Yes	13 (38.2)	12 (40.0)	0.21	.885
	No	21 (61.8)	18 (60.0)
CAG recognition	High	7 (20.6)	12 (40.0)	3.11	.212
	Middle	14 (41.2)	8 (26.7)
	Low	13 (38.2)	10 (33.3)
CAG experience	Yes	15 (44.1)	17 (56.7)	1.00	.316
	No	19 (55.9)	13 (43.3)
Stress (VAS)		4.50 (2.25)^§	5.00 (5.25)^§	−0.03^††	.978
Stress index (score)		6.09±2.21	6.23±2.37	0.25	.801
Blood pressure (mmHg)	Systolic blood pressure	130.00 (10.00)^§	130.00 (10.00)^§	−0.98^††	.329
	Diastolic blood pressure	80.00 (20.00)^§	80.00 (10.00)^§	−0.97^††	.334
Heart rate variability	Low frequency	4.39±0.95	4.48±1.14	0.33	.744
	High frequency	4.19±1.07	4.38±1.16	0.69	.498

Exp.=Experimental group; Cont.=Control group; CAG=Coronary angiography; VAS=Visual analogue scale; M=Mean; SD= Standard deviation; IQR=Interquartile range.

^†Fisher’s exact test; ^††Mann-Whitney U test; ^§Median IQR.

Table 2.

Comparison of Stress, Nerve Activity, and Blood Pressure between Groups (N=64)

Variables	Group	Time					Sources F/χ²(p)	^T₁	^T₂	^T₃	^T₄
		Admission (T₀)	Pre CAG (T₁)	Post CAG (T₂)	Post CAG at 2 hours (T₃)	Post CAG at 4 hours (T₄)		t/z (p)	t/z (p)	t/z (p)	t/z (p)
		M±SD	M±SD	M±SD	M±SD	M±SD
Stress
Stress	Exp.	4.26±2.39	4.41±2.39	1.94±2.39	0.68±1.25	0.28±0.80	102.26^††	0.23	−1.30^†	2.31^†	−1.43^†
score	(n=34)						(<.001)	(.817)	(.192)^†	(.021)^†	(.152)^†
(VAS)	Cont.	4.10±3.00	4.57±2.94	2.93±2.75	1.50±1.55	0.97±1.83	59.35^††
	(n=30)						(<.001)
Stress	Exp.	6.09±2.21		4.76±2.13		4.29±1.72	12.27^††		2.99^†		2.41^†
index	(n=34)						(.002)		(.003)^†		(.016)^†
	Cont.	6.23±2.37		6.27±2.33		5.43±2.25	38.63^††
	(n=30)						(<.001)
Nerve activity
LF activity	Exp.	4.39±0.95		4.33±0.53		4.32±0.64	Time		2.58		1.89
	(n=34)						0.18 (.836)		(.012)		(.064)
	Cont.	4.48±1.14		4.68±0.54		4.60±0.48	Group
	(n=30)						4.55 (.037)
							Group×Time
							0.39 (.678)
HF activity	Exp.	4.19±1.07		4.88±0.92		5.16±0.91	Time		−3.70		−2.97
	(n=34)						8.45 (.001)		(<.001)		(.004)
	Cont.	4.38±1.16		3.95±1.09		4.44±1.03	Group
	(n=30)						6.44 (.014)
							Group×Time
							5.85(.005)
Blood pressure
SBP	Exp.	129.41±10.13	122.21±9.47	117.65±10.24	113.97±7.76	112.35±6.99	85.85^††	−1.14^†	2.79^†	3.93^†	4.14^†
(mmHg)	(n=34)						(<.001)	(.255)^†	(.005)^†	(<.001)^†	(<.001)^†
Cont.	126.83±9.87	124.67±11.14	123.82±9.07	123.50±9.39	122.00±8.87	7.85^††
	(n=30)						(.096)
DBP	Exp.	77.94±7.70	75.29±7.70	72.21±4.95	69.56±8.12	69.71±5.07	46.47^††	−0.19^†	−1.47^†	2.71^†	3.28^†
(mmHg)	(n=34)						(<.001)	(.853)^†	(.141)^†	(.007)^†	(.001)^†
	Cont.	76.33±6.69	75.67±7.85	74.33±6.79	74.33±5.68	74.33±5.83	4.42^††
	(n=30)						(.352)

Exp.=Experimental group; Cont.=Control group; CAG=Coronary angiography; T0=Admission; T1=Pre CAG; T2=Post CAG; T3=2 hours after CAG; T4=4 hours after CAG; LF=Low frequency; HF=High frequency; SBP=Systolic blood pressure; DBP=Diastolic blood pressure; VAS=Visual analogue scale; M=Mean; SD=Standard deviation.

^†Mann-Whitney U test; ^††Friedman test.

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