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Sleep Patterns and Sleep-Impairing Factors of Persons Providing Informal Care for People With Cancer: A Critical Review of the Literature

Kotronoulas, Grigorios MSc, BSN; Wengstrom, Yvonne PhD, OCN¨; Kearney, Nora MSc, RGN

doi: 10.1097/NCC.0b013e3182456c38

Background: Sleep is increasingly recognized as an area of functioning that may be greatly affected in persons who are practically and emotionally involved in the care of patients with cancer. Clinician awareness is required to ensure that effective care for informal caregivers with sleep problems is provided.

Objective: A 2-fold critical review of the published literature was conducted, which aimed at summarizing and critically analyzing evidence regarding sleep patterns of informal caregivers of adults with cancer and contributing factors to sleep-wake disturbances.

Methods: Using a wide range of key terms and synonyms, 3 electronic databases (MEDLINE, CINAHL, EMBASE) were systematically searched for the period between January 1990 and July 2011.

Results: Based on prespecified selection criteria, 44 articles were pooled to provide evidence on sleep-impairing factors in the context of informal caregiving, 17 of which specifically addressed sleep patterns of caregivers of people with cancer.

Conclusions: At least 4 of 10 caregivers may report at least 1 sleep problem. Short sleep duration, nocturnal awakenings, wakefulness after sleep onset, and daytime dysfunction seem to be the areas most affected irrespective of stage or type of disease, yet circadian activity remains understudied. In addition, despite a wide spectrum of potential sleep-impairing factors, underlying causal pathways are yet to be explored.

Implications for Practice: More longitudinal, mixed-methods, and comparison studies are warranted to explore caregiver sleep disorders in relation to the gravity of the caregiving situation in the context of diverse types of cancer and disease severity.

Author Affiliations: School of Nursing & Midwifery, University of Dundee, Scotland (Mr Kotronoulas, Prof Wengstro¨m, and Prof Kearney); and Department of Neurobiology, Division of Nursing, Care Science and Society, Karolinska Institutet, Huddinge, Sweden (Prof Wengström).

Mr Kotronoulas has received a PhD scholarship from the “Alexander S. Onassis” Public Benefit Foundation and an educational grant from the Hellenic Society of Medical Oncology, both in Athens, Greece.

The authors have no conflicts of interest to disclose.Correspondence: Grigorios Kotronoulas, MSc, BSN, School of Nursing & Midwifery, University of Dundee, 11 Airlie Pl, DD1 4HJ, Scotland (

Accepted for publication December 5, 2011.

© 2013 Lippincott Williams & Wilkins, Inc.