Family Caregivers of People with Dementia Have Poor Sleep Quality: A Nationwide Population-Based Study

Abstract

Previous studies have documented cognitive impairments, psychological stress, and depressive symptoms in family caregivers of people with dementia (PWD), which could be attributed to their sleep disturbances. Notwithstanding the increasing recognition of poor sleep quality and sleep disturbances in family caregivers of PWD, their association has not been tested yet using population-representative samples. We conducted a retrospective, cross-sectional study using population-based data from the 2018 Korean Community Health Survey. Sociodemographic, mental health-related, and physical health-related variables as well as sleep quality evaluated by the Pittsburgh Sleep Quality Index (PSQI) were compared between 2537 cohabitating caregivers of PWD, 8864 noncohabitating caregivers of PWD, and 190,278 non-caregivers. Two sets of multivariable logistic regressions were conducted to examine the associations between dementia caregiving and poor sleep quality in cohabitating and noncohabitating caregivers versus noncaregivers. Both cohabitating and noncohabitating caregivers had higher global PSQI scores and higher prevalence of poor sleep quality (PSQI score > 5) than did noncaregivers. Multivariable logistic regressions adjusted for potential confounders revealed that cohabitating caregivers (odds ratio (OR) 1.26, 95% confidence interval (CI) 1.15–1.38) and noncohabitating caregivers (OR 1.15, CI 1.10–1.21) were significantly associated with poor sleep quality. Our results showed that both cohabitating and noncohabitating caregivers of PWD experienced overall poorer sleep quality compared to noncaregivers, indicating the deleterious effect of dementia caregiving on sleep quality, regardless of living arrangements. Given the high prevalence of poor sleep quality in family caregivers of PWD and the increasing awareness of the serious health consequences of poor-quality sleep, physicians should consider active sleep interventions to promote health and wellbeing not only for the dementia patients but also for family caregivers.

Family Caregivers of People with Dementia Associate with Poor Health-Related Quality of Life: A Nationwide Population-Based Study

“…The deleterious impacts of family caregiving on mental and physical as well as cognitive functions have also been demonstrated in prior investigations. More specifically, the family caregivers of patients with various dementia disorders were more likely to have an increased risk of cardiovascular diseases [ 74 , 75 , 76 ], poor physical health status [ 13 , 16 , 24 ], poor psychological health status including strain, depression, and anxiety [ 25 , 77 , 78 , 79 ], sleep disturbances and poor sleep quality [ 19 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ], and cognitive impairments [ 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Consistent with the aforementioned studies, the fully adjusted model of the current study disclosed that caregivers had a higher frequency of diabetes mellitus, hypertension, depression, subjective cognitive decline, and poor sleep quality relative to noncaregivers (all p < 0.001).…”

“…The sample size is 900 participants in each of the 254 community health units located in 17 metropolitan cities and provinces, and the expected total number of participants is 228,600. The KCHS utilized a two-stage sampling procedure to assure a better representation of the general population, as described in detail elsewhere [ 33 , 53 ]. A total of 32,612 out of 228,340 participants were ruled out because they did not fill in the survey variables listed in Table 1 and Table 2 , and consequently, 195,728 participants were eventually included in the statistical analysis.…”

“…Moreover, it has been shown that compared to noncaregivers, caregivers of PWD exhibited poorer cognitive performance in verbal memory, attention, and frontal executive function [ 17 , 18 , 19 , 20 , 21 , 22 , 23 ], which may be potentially attributed to their chronic stress related to dementia caregiving and psychological factors [ 24 ]. Poor sleep quality and sleep disturbances that have been well documented in family caregivers of PWD might also be implicated in their cognitive impairments [ 19 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

Sleep and Anabolic/Catabolic Hormonal Profile in Sedentary Middle-Aged Adults: The FIT-AGEING Study

“…Concretely, our study showed differences between subjective and objective sleep assessments, since WASO was positively associated with cortisol plasma levels, and SE was negatively related to cortisol plasma levels in women. Previous studies have revealed weak or inconsistent correlations of subjective (i.e., PSQI scores) with objective (e.g., actigraphy and polysomnography) measures [ 58 , 59 , 60 ]. In fact, it has been shown that the PSQI and the accelerometer may assess different attributes of sleep [ 61 ].…”

Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons with Dementia in Sweden

“…The level of impairment in PwD is associated with negative outcomes among carers, for example, higher levels of sleep disturbance, stress related conditions, and poorer health [3,[7][8][9][10][11]. Other individual and contextual factors are also associated with poorer health outcomes in carers of PwD, including greater age of the carer, co-habitation with the care-recipient, and a longer duration of being a carer [10,[12][13][14][15], all factors that characterise a spouse carer more so than a non-spouse carer.…”