Assessing the quality of sleep in Greek primary caregivers of patients with secondary progressive multiple sclerosis: a cross-sectional study

Examining the Impact of Different Components of Sleep Quality on Anxiety Among Family Carers of People with Dementia

Existing interventions for family carers of people with dementia tend to be less effective for anxiety than for depression. Therefore, identifying factors affecting carer anxiety is important to inform future interventions. This study conducted 2 multiple regression analyses using a sample of 91 family carers. The first regression model (∆R² = .24), exploring the impact of demographic variables and carer stressors, demonstrated that hours of caring (β = .33) and overall sleep quality (β = .28) were significant predictors of anxiety. To further investigate the impact of sleep quality, the second model (∆R² = .24) focussed on exploring the differential impact of various components of sleep quality on anxiety. Findings demonstrated that subjective sleep quality (β = .33) and sleep disturbances (β = .22) were significant predictors. Hours of caring per week, subjective sleep quality and sleep disturbances seem to be critical for treating anxiety in family carers. Future studies should investigate whether targeting these variables could improve carer anxiety.

Multiple sclerosis caregiving: A systematic scoping review to map current state of knowledge

Unpaid caregivers, typically family and friends, provide significant amounts of support to people with multiple sclerosis (MS). Understanding their experiences, needs and challenges is necessary to ensure that caregivers receive the support that they require to continue in their role. Our aim was to map the current state of knowledge about unpaid caregivers of people with MS and identify gaps in knowledge to guide future research and practice. We used scoping review methodology with three major health-related databases (MEDLINE, CINAHL, APA Psychinfo), searching in September 2019, April and October 2020 and October 2021. We selected peer-reviewed scientific articles reporting on primary studies of unpaid caregivers of people with MS, regardless of topic or research design. We extracted information on study aim, participant characteristics, measures used and key findings to generate major themes and identify knowledge gaps. We identified 108 published studies between 1992 and 2021 that met our criteria. Studies of spousal caregivers were most common. Studies focused primarily on measurement of caregiver burden or other negative consequences of caregiving. Thirteen studies addressed positive consequences of caregiving. Sixteen studies reported actual tasks performed by caregivers and seven reported outcomes of caregiver support interventions. Attention to diversity issues that may influence caregiving experiences and outcomes was rare. Overall, knowledge of MS caregiving is limited, particularly with respect to tasks performed by caregivers that may contribute to negative outcomes, diversity issues and effective approaches to remediate caregiver burden. Without this knowledge, finding ways to better support MS caregivers will be difficult.

Disease activity and sleep quality in rheumatoid arthritis: a deeper look into the relationship

Objectives: This study looks deeper into the relationship between rheumatoid arthritis (RA) disease activity and distinct dimensions of sleep quality. Methods: The Pittsburgh Sleep Quality Index (PSQI) was administered to a cohort of 147 RA patients. Health-related quality of life (HRQoL) and fatigue were measured with the SF-12 and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) instruments, respectively, whereas RA activity was determined with the Disease Activity Score 28 joints (DAS28). Ethical approval for the study and informed consent from the participants were obtained. Results: Most patients were females (78.2%), and the mean age of the entire sample was 63.7 years. Most participants (77.6%) were poor sleepers (i.e. PSQI ≥ 5) who suffered from fatigue more than good sleepers (FACIT-F: 21.6 vs. 39.3, p < 0.001). Overall sleep quality correlated, in the expected directions, with disease activity (Spearman's rho = 0.87, p < 0.001), physical health (-0.66, p < 0.001), mental health (-0.71, p < 0.001), and fatigue (0.87, p < 0.001). PSQI and its component scores differed across patient subgroups with increasing RA activity, even after adjusting for confounding variables. Conclusion: RA disease activity distinctly affects sleep quality, and given the already demonstrated importance of good sleep, this 'deeper look' might contribute to the effort to improve HRQoL in RA patients.

Sleep disturbances in caregivers of patients with advanced cancer: A systematic review

OBJECTIVE

Sleep disturbances are a common issue for those who provide informal care to someone with a life-limiting condition. The negative consequences of poor sleep are well documented. The purpose of the present study was to determine the sleep patterns of caregivers of patients with advanced cancer.

METHOD

An extensive systematic review of studies reporting empirical sleep data was undertaken in 2015 in accordance with the PRISMA Statement. A total of eight electronic databases were searched, with no date restrictions imposed. Additionally, a search of the bibliographies of the studies identified during the electronic search was conducted. Search terms included: "sleep," "insomnia," "sleep disturbance," "circadian rhythm," "caregiver," "carer," "advanced cancer," "palliative cancer," and MESH suggestions. The inclusion criteria required studies to be in English and to report primary qualitative and/or quantitative research that examined sleep in caregivers of patients with advanced cancer. Unpublished studies, conference papers, and dissertations were excluded.

RESULTS

Overall, 10 studies met the inclusion criteria and were included in the review. Two major findings emerged from the data synthesis. First, at least 72% of caregivers reported moderate to severe sleep disturbance as measured by the Pittsburgh Sleep Quality Index. Second, objective measurement of caregivers' sleep identified that some caregivers experienced up to a 44% reduction in their total sleep time compared to the recommended eight hours.

SIGNIFICANCE OF RESULTS

Reduction in total sleep time appears to be the biggest issue facing caregivers' sleep. Future studies need to explore the specific factors that cause these sleep disturbances and thus help to identify interventions to optimize sleep.

Associations of self-reported and objectively measured sleep disturbances with depression among primary caregivers of children with disabilities

OBJECTIVE

The objective of this study was to determine the association between sleep and depression using both self-reported (subjective) and actigraphic (objective) sleep traits.

METHODS

A cross-sectional study was conducted among 175 female primary caregivers of children with disabilities receiving care at a rehabilitation center in Punta Arenas, Chile. The eight-item Patient Health Questionnaire was used to ascertain participants' depression status. The Pittsburgh Sleep Quality Index was used to define subjective, or perceived, sleep quality. Wrist-worn actigraph monitors, worn for seven consecutive nights, were used to characterize objective sleep quality and disturbances. Interviewer-administered questionnaires were used to collect information on sociodemographic and lifestyle factors. Linear regression models were fit using continuous sleep parameters as the dependent variables and depression status as the independent variable. Multivariable models were adjusted for body mass index, marital status, smoking status, education level, and children's disabilities.

RESULTS

Using an eight-item Patient Health Questionnaire score ≥10, 26.3% of participants presented with depression. Depressed women were more likely to self-report overall poorer (subjective) sleep compared to non-depressed women; however, differences in sleep were not consistently noted using actigraphic (objective) sleep traits. Among the depressed, both sleep duration and total time in bed were significantly underestimated. In multivariable models, depression was negatively associated with sleep duration using both subjective (β=-0.71, standard error [SE] =0.25; P=0.006) and objective sleep (β=-0.42, SE =0.19; P=0.026).

CONCLUSION

The association between sleep and depression differed comparing subjective and objective methods of assessment. Research strategies allowing for the integration of both perceived and objective measures of sleep traits are encouraged.

Care Partners and Multiple Sclerosis: Differential Effect on Men and Women

BACKGROUND

Caring for someone with multiple sclerosis (MS) can be a stressful experience that requires clinical attention. We investigated the impact of caregiver stress on the emotional well-being and physical health of the MS care partner using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry.

METHODS

Care partners of NARCOMS participants were invited to complete an online questionnaire that captured demographic characteristics, health status, caregiver burden as measured by the Zarit Caregiver Burden Interview, and impact of caregiving on employment.

RESULTS

Of 1446 care partners who agreed to participate, 1333 had complete data. Most were men (n = 825, 61.9%), with a mean (SD) age of 51.1 (11.2) years. The mean (SD) Zarit total score was 24.6 (15.1), placing the overall group in the mild caregiver burden range. Compared with male care partners, female care partners reported higher levels of burden and stress and more medication use for stress/anxiety and mood disorders. Male care partners were more likely to report physical concerns. Care partners of people with primary progressive MS reported greater perceived burden than did partners of people with secondary progressive MS and relapsing-remitting MS. More than 40% of care partners (559 of 1288) had missed work during the past year owing to caregiving responsibilities.

CONCLUSIONS

Care partners of people with MS have substantial physical and psychological health concerns and experience an adverse impact on employment. Future research should evaluate how to mitigate the adverse effects of caregiving and evaluate positive aspects of the role.

The impact of multiple sclerosis on family members: a review of the literature

Multiple sclerosis (MS) is one of the most common neurological diseases in young adults and involves inflammatory demyelination of the CNS. MS typically manifests between 20 and 40 years of age, and can lead to significant disability in some cases. The disease course is unpredictable. MS has a significant impact on families, influencing their wellbeing and quality of life, often creating psychological stress in each family member as well as on family functioning in general. Common themes include the impact of the emotional state of the person with MS on family members, the role of the healthy parent on how children cope, the effect of a lack of information about MS, communication within the family and with healthcare professionals, and the importance of assessing and treating families as a dynamic unit in order to assure comprehensive intervention plans. The current literature review is based on 30 full research articles meeting inclusion criteria related to partners/couples, family caregivers, children with a parent with MS and parents of young children with MS.

Burden and quality of life in caregivers of persons with multiple sclerosis

Multiple sclerosis (MS) is the second most common cause of disability among nervous system diseases. This disease causes reduced quality of life of patients and those caring for them. Quality of life (QoL) measures consist of at least three broad domains: physical, mental and social. In the field of medicine, researchers have often used the concept of health-related quality of life, which specifically focuses on the impact of an illness and/or treatment on patients' perception of their status of health and on subjective well-being or satisfaction with life. Subjective factors of QoL in MS patients include perception of symptoms, level of fitness, self-image, satisfaction with family life, work, the economic situation, interaction with other people, social support and life in general. Objective factors include the clinical picture of disease, social status, social and living conditions and the number and intensity of social contacts. While many generic and specific questionnaires have been developed to assess QoL in patients with MS, including general fatigue, there is a lack of specific questionnaires assessing QoL of caregivers. In this paper, a review of selected studies on QoL and caregiver burden in MS and a summary of the most popular questionnaires measuring burden and QoL are presented. Special attention is paid to the first questionnaire specific for QoL of carers of persons with MS, CAREQOL-MS by Benito-León et al.