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Lisa J. Meltzer, PhD; Jodi A. Mindell, PhD

Arch Intern Med. 2006;166:1749-1755.

Background  Chronic illness may not only directly impact the sleep of a patient but also indirectly impact the sleep of the family members who provide nighttime care. For parents of children with chronic illnesses, few studies have examined sleep disruptions that may account for elevated rates of depression and fatigue. Our objectives were to examine sleep patterns and causes of sleep disturbances in caregivers of children with and without chronic illnesses and to determine whether sleep mediates the relationship between a child's chronic illness and daytime functioning in caregivers.

Methods  A total of 118 mothers of children with ventilator dependency (VENT), cystic fibrosis (CF), or healthy children (HEALTHY) completed a series of self-reported measures during a structured telephone interview, including the Pittsburgh Sleep Quality Index, the 24-Hour Sleep Patterns Interview, the Child Health Questionnaire–General Health Scale, the Center for Epidemiological Studies–Depression Scale, and the Iowa Fatigue Scale.

Results  Ventilator dependency caregivers reported an earlier morning wake time and shorter total sleep time than both CF and HEALTHY caregivers. In addition, VENT caregivers reported more night wakings and poorer sleep quality than HEALTHY caregivers. Frequent sleep disruptions for VENT caregivers were due to nighttime caregiving, while almost 40% of both VENT and CF caregivers reported sleep disruptions due to stress related to their child's health. Finally, caregiver sleep quality was found to mediate the relationship between child health and caregiver depression and fatigue.

Conclusions  Sleep in caregivers of children with chronic illnesses, in particular ventilator dependency, is significantly disrupted, resulting in chronic partial sleep deprivation. Owing to the level of attention and care required by these children, interventions and support for caregivers to improve their sleep quality and quantity are necessary.

Author Affiliations: Division of Pulmonary Medicine, The Children's Hospital of Philadelphia (Drs Meltzer and Mindell), Department of Pediatrics, The University of Pennsylvania (Dr Meltzer), and Department of Psychology, Saint Joseph's University (Dr Mindell), Philadelphia.

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