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Factors Associated With Caregiver Reports of Sleep Disturbances in Persons With Dementia

From the Departments of Psychosocial and Community Health (SMM, RGL, LT), Psychiatry and Behavioral Sciences (MVV), and General Internal Medicine (LEG), University of Washington, Seattle, WA.

Objective: This investigation examined the relationship between caregivers’ reports of sleep disturbances in persons with Alzheimer disease (AD) and actigraphic records of patients’ sleep–wake activity, and explored the factors associated with discrepancies in this relationship.

Method: Forty-six patients with AD living with their caregivers participated. Before study entry, all caregivers reported poor patient sleep quality using the Neuropsychiatric Inventory (NPI) Nighttime Behavior Scale. Patient sleep–wake activity was recorded for one week using an Actillume wrist-movement recorder.

Results: Although all patients were reported by caregivers to have multiple sleep disturbances, 41% of patients had actigraphic sleep efficiencies in the normal range and 43% averaged eight or more hours of sleep nightly. In bivariate analyses, greater patient percent nighttime sleep (indicative of more discrepancy between subjective reports and objective outcomes) was associated with less patient cognitive, physical and functional impairment, lower self-rated depression, higher self-rated quality of life, and less daytime sleepiness. No patient variable significantly predicted total patient nocturnal sleep time. In both bivariate and multivariate analyses, greater patient percent sleep and total sleep time were also associated with caregiver factors, particularly greater use of criticism as a behavior management strategy.

Conclusion: The study suggests that both patient and caregiver factors contribute to reported sleep problems in community-dwelling patients with AD, and that caregiver reports and objective sleep assessments frequently may not agree. Treatments should consider these dyadic contributions rather than focusing on caregiver reports of patient symptoms alone.

Key Words: Sleep • nocturnal disturbances • Alzheimer disease • caregivers • actigraphy