Calidad de sueño en los cuidadores informales de pacientes hospitalizados

Resumo

Background: Sleep problems in caregivers are associated with caregiver factors, such as burden, anxiety, or depression; care-recipient factors, such as dependence; and carerelated factors, such as chronicity. Care-recipient hospital admission is a stressful event for caregivers, placing their sleep at risk. In addition to care-related needs, caregivers must cope with a poor sleep environment. However, sleep problems in caregivers of patients admitted to the hospital are scarcely explored. Objectives: The study had several objectives. First, to establish the prevalence of insomnia symptoms and analyze their related caregiver factors, care-recipient factors and hospital environment factors (objectives 1, 2 and 3). We also aimed to determine objective sleep quality in caregivers during patient hospital admission and test the association between caregiver sleep quality and caregiver location (home vs. hospital) (objective 4). A final objective was to measure changes in insomnia and other psychological variables one month after patients’ hospital discharge (objective 5). Methodology: n = 152 caregivers of patients admitted to the hospital were recruited. In the first phase of the study (objectives 1 to 4), a cross-sectional descriptive study was used to determine the prevalence of insomnia symptoms. In the second phase, caregivers were invited to create a cohort for a prospective study (objective 5). In the first phase, the prevalence of insomnia symptoms was explored using the Insomnia Severity Index (ISI), using a 15-point cut-off score. Next, two logistic regression models were used to analyze the factors associated with caregiver sleep. The first model included all caregivers (n = 152), whereas the second one included only those who slept exclusively at the hospital or alternated with their home (n1 = 123). To determine objective caregiver sleep quality, caregivers were asked to wear the MotionWatch 8© actigraph for 7 days. Results were described and compared according to caregivers’ sleep location (hospital vs. home) using a mixed model analysis controlled by age, sex and hypnotics intake. In the second phase (i.e., with the cohort), paired t test were used to determine mean differences for each questionnaire due to the small sample size (n3 = 37). Results: 45.4% of caregivers of a family member admitted to the hospital had moderate to severe insomnia symptoms. The main factors associated with such symptoms were high educational level (ORa = 5.50; 95% CI: 1.34-22.63) and caregiver’s anxiety (ORa = 1.15; 95% CI: 1.01-1.31). Additionally, care-recipients’ neuropsychiatric symptoms showed a trend toward statistical significance as well (ORa = 1.09; 95% CI: 1.00-1.20). Moreover, in caregivers who slept at the hospital or alternated with their home, hospital sleep disruptors were also associated with insomnia symptoms (ORa = 1.09; 95% CI: 1.01-1.17). Regarding objective sleep quality, 38.4% of caregivers showed bad sleep quality (i.e., sleep efficiencies under 80%) when caring for a relative at the hospital. Caregiver showed better sleep quality on the nights that they slept at home, compared to those spent at the hospital. Specifically, caregivers who slept at home showed less wake after sleep onset (43 minutes vs. 65 minutes), a lower fragmentation index (24.3% vs. 33.9%), and better sleep efficiency (87.7% vs. 82.6%) (p < 0.05). Yet, one month after care-recipients’ hospital discharge, caregivers did not show any improvement in their sleep quality or other related variables. Conclusions: Informal caregivers of patients admitted to the hospital showed a high prevalence of sleep problems. Caregivers should be advised about the importance of a good night’s sleep for their health and for their care role. Hospital health workers should encourage caregivers to rest at home whenever possible. For caregivers who choose to sleep at the hospital, hospitals should provide individual rooms to avoid some of the hospital environmental sleep disruptors. Additionally, health workers and institutions should contribute to a good night’s sleep in the hospital, conducting programs aimed at noise reduction and care-respecting plans. Lastly, advantage should be taken of health workers’ proximity to develop interventions aimed at increasing caregivers’ quality of life. Such interventions would not only impact caregivers but also care-recipients.