title: Avoidant Coping and Poor Sleep Efficiency in Dementia Caregivers.
abstract: OBJECTIVE
  Caring for a spouse with dementia is a source of chronic stress and is associated with a heightened prevalence of self-reported sleep problems. Styles and strategies for coping with stress have been associated with objective measures of sleep in non-caregiver populations. The current study evaluated relationships between caregiver coping style and sleep disturbance using in-home polysomnography.
  
  
  METHODS
  Sixty spousal caregivers (mean [standard deviation] age = 73.31 [7.05] years; 81.7% female) completed the Brief Cope, the Hamilton Rating Scale for Depression, and three nights of in-home polysomnography. Participants were categorized into two groups based on the presence or absence of clinically significant low sleep efficiency (<80%). A factor analysis of the Brief Cope yielded higher-order factors that included approach coping and avoidant coping (explained variance, 27.2% and 16.9%, respectively). Coping factors were entered into a binary logistic regression predicting sleep efficiency group while controlling for sleep apnea, medication use, and depression, as measured by the Hamilton Rating Scale for Depression.
  
  
  RESULTS
  In fully adjusted models, for each unit increase on the avoidant coping factor, participants were 3.4 times more likely to be classified in the low sleep efficiency group (B = 1.224, χ2(1) = 4.967, p = .026, exp(B) = 3.401, 95% confidence interval = 1.159-9.981). Approach coping was unrelated to sleep efficiency in both adjusted and unadjusted models.
  
  
  CONCLUSIONS
  These findings highlight the importance of coping among caregivers and indicate that avoidant coping may be a modifiable predictor of sleep disturbance in conditions of chronic stress.
authors.affiliation: From the Department of Psychology (Taylor, Schulz), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychology (Irish), North Dakota State University, Fargo, North Dakota; Department of Human Development and Family Studies (Martire), Pennsylvania State University, State College, Pennsylvania; Department of Psychiatry (Siegle, Hall), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and Department of Biostatistics (Krafty), University of Pittsburgh, Pennsylvania.
authors.forename: Briana J
authors.initials: BJ
authors.lastname: Taylor
authors.forename: Leah A
authors.initials: LA
authors.lastname: Irish
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Martire
authors.forename: Greg J
authors.initials: GJ
authors.lastname: Siegle
authors.forename: Robert T
authors.initials: RT
authors.lastname: Krafty
authors.forename: Richard
authors.initials: R
authors.lastname: Schulz
authors.forename: Martica H
authors.initials: MH
authors.lastname: Hall
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D001362:Avoidance Learning; D015992:Body Mass Index; D017028:Caregivers / Q000523:psychology*; D003704:Dementia; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography / Q000379:methods; D057566:Self Report; D012892:Sleep Deprivation / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D018454:Spouses / Q000523:psychology*; D013312:Stress, Physiological; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires