Abstract

In the United States, 16 million family caregivers provide long-term care for patients with dementia. Although one's physical, mental, and cognitive health depends on sleep, many caregivers experience chronic stress, and stress is typically associated with worse sleep quantity and quality. To quantify the extent, nature, and treatability of sleep problems in dementia caregivers. PubMed and Scopus databases were systematically searched for articles published through June 2018 using the following keywords: caregiver or spouse or caretaker AND sleep or circadian AND dementia or Alzheimer. Backward citation tracking was performed, and corresponding authors were contacted for additional data to conduct meta-analyses and pooled analyses. Two reviewers independently screened 805 studies to identify those that reported sleep duration or sleep quality in caregivers of patients with dementia. Following the PRISMA guidelines, 2 reviewers independently extracted data from all studies and conducted National Heart, Lung, and Blood Institute study quality assessments. Meta-analyses with random-effects models were performed to evaluate sleep duration, sleep quality, and sleep interventions in dementia caregivers. Sleep quality and total sleep time were measured by polysomnography, actigraphy, and self-report. Thirty-five studies were analyzed with data from 3268 caregivers (pooled mean age [SD of sample means], 63.48 [5.99] years; 76.7% female) were analyzed. Relative to age-matched control noncaregiver adults, caregivers had lower sleep durations akin to losing 2.42 to 3.50 hours each week (Hedges g = -0.29; 95% CI, -0.48 to -0.09; P = .01). Sleep quality was significantly lower in caregivers (Hedges g = -0.66; 95% CI, -0.89 to -0.42; P < .001), but caregivers who underwent sleep intervention trials had better sleep quality than caregivers who did not receive a sleep intervention (Hedges g = 0.35; 95% CI, 0.20-0.49; P < .001). Sleep debt is known to have cumulative associations with physical, mental, and cognitive health; therefore, poor sleep quality in dementia caregivers should be recognized and addressed. Although the caregiving role is stressful and cognitively demanding by its nature, better sleep quality was observed in caregivers who received low-cost behavioral interventions.

Highlights

  • Dementia affects approximately 50 million adults globally, with this number expected to increase by 2050 to 131 million.[1]

  • Sleep quality was significantly lower in caregivers (Hedges g = −0.66; 95% CI, −0.89 to −0.42; P < .001), but caregivers who underwent sleep intervention trials had better sleep quality than caregivers who did not receive a sleep intervention (Hedges g = 0.35; 95% CI, 0.20-0.49; P < .001)

  • We analyzed 35 studies to quantify the differences in total sleep time and sleep quality between 3268 caregivers and 696 noncaregiving controls

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Summary

Introduction

Dementia affects approximately 50 million adults globally, with this number expected to increase by 2050 to 131 million.[1]. In the United States, this lack of independent functioning has spurred 16 million adults to become informal caregivers to their spouse, parent, or friend who has Alzheimer disease or a related dementia.[3] Caregiving for patients with dementia is akin to adding a part-time job. Caregiving is emotionally and cognitively demanding, and an accumulating literature indicates that caregivers’ overall health is adversely altered.[4] Cognitive functioning may decline in caregivers, with studies reporting lower performance relative to age-matched control adults on tests of verbal memory[5] and attention.[6] One possibility is that sleep disturbances exacerbate the observed changes to mental, physical, and cognitive health.[4] For example, mechanistic work has shown that acute and chronic sleep problems are associated with difficulties regulating stressors, quicker cortical thinning, and lower glymphatic clearance of β-amyloid from interstitial space.[7,8,9]

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