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Caregiver Sleep and Patient Neutrophil Engraftment in Allogeneic Hematopoietic Stem Cell Transplant

A Secondary Analysis

Sannes, Timothy S. PhD; Mikulich-Gilbertson, Susan K. PhD; Natvig, Crystal L. BS; Brewer, Benjamin W. PsyD; Simoneau, Teresa L. PhD; Laudenslager, Mark L. PhD

doi: 10.1097/NCC.0000000000000447

Background: Caregiving for allogeneic hematopoietic stem cell transplant (Allo-HSCT) patients can be significantly burdensome. Caregiver well-being often mirrors patients' suffering. However, to our knowledge, this dyadic relationship has not been linked to patient outcome.

Objective: Caregiver's objective and subjective sleep and overall distress before transplantation were hypothesized to be related to patient's time to engraftment in secondary analyses.

Methods: Dyads (N = 124) were Allo-HSCT patients (mean [SD] age, 49.2 [12.7] years) and their caregivers (mean [SD] age, 52.7 [12.3] years). Caregiver's subjective sleep quality was measured via the Pittsburgh Sleep Quality Index, objective sleep was measured by actigraphy, and distress was measured by combining validated psychological measures.

Results: Both caregiver reports of worse sleep (β = .22; P < .05) and objective measurement of caregiver sleep patterns (higher sleep efficiency; less time awake after sleep onset) collected before engraftment significantly predicted shorter time to patient engraftment (β values = −.34 and .29, respectively; P values < .05). Caregiver distress was unrelated to engraftment (β = .14; P = .22).

Conclusions: Despite limitations in available patient data, these findings appear to link caregiver well-being to patient outcome. This underscores the interrelatedness of the patient-caregiver dyad in Allo-HSCT. Future research should examine psychological and biomedical mediators.

Implications for Practice: Given that caregiver well-being during the peritransplantation period was associated with patient outcome in this study, such findings highlight the need to address caregiver and patient well-being during Allo-HSCT. There may be potential to improve patient outcome by focusing on the caregiver, which nursing staff is well positioned to monitor.

Author Affiliations: Departments of Psychiatry (Drs Sannes, Mikulich-Gilbertson, and Laudenslager and Ms Natvig), General Internal Medicine (Dr Sannes), and Medicine (Dr Brewer), University of Colorado Denver, Anschutz Medical Campus, Aurora; VA Eastern Colorado Health Care System, Denver (Dr Simoneau).

Supported in part by National Institutes of Health grant T32AG044296 (T.S.S.), CA126971 (M.L.L.), and DA034604 (S.M.G.) and PCORI contract CE-1304-6208 (M.L.L.).

All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee, as well as the National Institutes of Health.

The authors have no conflicts of interest to disclose.

Correspondence: Timothy S. Sannes, PhD, Department of Psychiatry, University of Colorado Denver, Anschutz Medical Campus, RC-2, Room 3410A; Mailstop: C268-09, 12700 E. 19th Ave Aurora, CO 80045 (

Accepted for publication September 20, 2016.

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