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Sleep-Wake Circadian Activity Rhythms and Fatigue in Family Caregivers of Oncology Patients

Dhruva, Anand MD; Lee, Kathryn PhD, RN, FAAN; Paul, Steven M. PhD; West, Claudia MS, RN; Dunn, Laura MD; Dodd, Marylin PhD, RN, FAAN; Aouizerat, Bradley E. PhD, MAS; Cooper, Bruce PhD; Swift, Patrick MD; Miaskowski, Christine PhD, RN, FAAN

doi: 10.1097/NCC.0b013e3182194a25

Background: Little is known about the relationships between sleep/wake circadian activity rhythms and fatigue in family caregivers (FCs) of oncology patients.

Objectives: The objectives of this study were to describe values for nocturnal sleep/rest, daytime wake/activity, and circadian activity rhythm parameters measured using actigraphy and to evaluate the relationships between these subjective and objective measures of sleep disturbance and self-reported fatigue severity, in a sample of FCs of oncology patients.

Methods: Family caregivers (n = 103) completed self-report measures for sleep disturbance (ie, Pittsburgh Sleep Quality Index, General Sleep Disturbance Scale) and fatigue (Lee Fatigue Scale) and wore wrist actigraphs for 48 hours prior to beginning radiation therapy. Spearman rank correlations were calculated between variables.

Results: Approximately 40% to 60% of FCs experienced sleep disturbance depending on whether clinically significant cutoffs for the subjective or objective measures were used to calculate occurrence rates. In addition, these FCs reported moderate levels of fatigue. Only a limited number of significant correlations were found between the subjective and objective measures of sleep disturbance. Significant positive correlations were found between fatigue and subjective, but not objective measures of sleep disturbance. The amplitude of circadian activity rhythm was not related to any objective sleep measure but was correlated with self-report of longer sleep-onset latency.

Conclusions: A significant percentage of FCs experience clinically meaningful disturbances in sleep-wake circadian activity rhythms. These disturbances occur primarily in sleep maintenance.

Implications for Practice: Family caregivers need to be assessed, along with patients, for sleep disturbance, and appropriate interventions initiated for them and for the patient.

Author Affiliations: Schools of Nursing (Drs Lee, Paul, Dodd, Aouizerat, Cooper, and Miaskowski, and Ms West) and Medicine (Drs Dhruva and Dunn), University of California, San Francisco; and Alta Bates Comprehensive Cancer Center, Berkeley, California (Dr Swift).

This research was supported by a grant from the National Institute of Nursing Research (NR04835). Dr Miaskowski receives support from the American Cancer Society as a Clinical Research Professor. Dr Aouizerat is funded through the National Institutes of Health Roadmap for Medical Research Grant (KL2 RR624130). Dr Dunn received funding from the Mount Zion Health Fund and the UCSF Academic Senate.

The authors have no conflicts of interest to disclose.

Correspondence: Christine Miaskowski, PhD, RN, FAAN, Department of Physiological Nursing, University of California, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610 (

Accepted for publication March 7, 2011.

© 2012 Lippincott Williams & Wilkins, Inc.