Effectiveness of respite care via short-stay services to support sleep in family caregivers

Author(s): Sakurai, S. and Kohno, Y.

Published In: Int. J. Environ. Res. Public Health, 17: 2428-2438

Study Aim/Purpose: Conducted in Japan between July 2015 and February 2017, this study analyzed the effects of “short-stay services” (i.e., one or more nights of overnight respite care) on the sleep of family caregivers living with an older person with dementia or with nocturnal awakening. 

Summary of Methods: A total of 17 caregivers began the study and seven had to be excluded, leaving a final study sample of 10 for the analysis. Participants completed a self-administered questionnaire one week prior to the first test day and at subsequent visits. The survey included caregiver demographic information, number of cohabitants, height, weight, lifestyle habits, health status, Pittsburgh Sleep Quality Index (PSQI) score, and length of the caregiving period. For one night after a caregiving day and one night during receipt of respite care, participants were asked to keep a sleep journal on the day following the study night. These provided supporting data in the sleep time/wake time analysis. Before going to sleep, each participant wore a fitted actigraph on their wrist as well as a heart rate sensor. The sleep variables determined with the actigraph were bedtime, wake-up time, duration of sleep time, sleep efficiency (sleep time/time in bed x 100), sleep latency (minutes between going to bed and sleep onset), and awake time between sleep onset and wake time. A heart rate sensor fixed to a specified site recorded heart activity during sleep and the results were quantified into high frequency (HF) and low frequency (LF). LF/HF was used as an index for cardiac sympathetic nervous activity balance. A higher LF/HF value indicated increased cardiac sympathetic nervous activity. Measurements were taken every five minutes for the whole night and totaled for the first and second half of the sleep time. 

Summary of Results: No significant differences in actigraph findings were found between caregiving and respite days. While the study participants had relatively high sleep efficiency, sympathetic nervous activity measurement revealed that the LF/HF value for the first half of the sleep period on the caregiving day was near the upper limit of standard range and PSQI scores from surveys exceeded those of the sleep disorder screening criteria. On respite care days, caregivers’ LF/HF value was significantly lower during the first half of the sleep period compared to nights after caregiving days. The authors note that on respite nights the LF/HF value for the first half of the sleep period was approximately the same level as reported among non-caregivers in other studies. Researchers found an even greater reduction in the LF/HF value on respite days among working caregivers compared to those who were not working. 

Limitations of Study: The authors acknowledged the limited generalizability of the study findings due to the small sample size and the limited duration of data collection (one night) for both conditions. 

Authors’ Discussion/Conclusions: Despite the study’s recognized limitations, the authors conclude that the objective data on autonomic nervous activity during sleep provide important evidence of the value of short-stay services in supporting improved sleep quality for caregivers. Given that family caregivers of older people who need care often experience sleep disorders and that the triggering of sympathetic nervous activity is associated with elevated blood pressure and related health problems, regular use of respite care may not only improve sleep quality for caregivers, but may also improve their health and quality of life by reducing risk of cerebral and cardiovascular disease.