***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Sleep disturbance is common in patients with advanced cancer , and their family carers also may suffer from sleep problems . The aims of this study were to determine the prevalence of sleep-wake disturbances in patients with advanced cancer and their carers , to monitor the amount of daytime spent in activity and rest , and to examine the relationship between sleep , physical , and psychological symptoms . This was a prospect i ve , descriptive observational study in patients with advanced incurable cancer and their carers attending a regional cancer center , using subjective ( Short Form-36 ,  Epworth Sleepiness Score , Hospital Anxiety and Depression Scale , Memorial Symptom Assessment Scale  , and  sleep history and diary ) and objective ( Actiwatch ) assessment s over a seven-day period . Sixty patients with advanced cancer and their family carers completed the study .  Poor sleep was a frequent complaint : 47 % of the patients and 42 % of the carers reported that they did not sleep well , yet patients reported sleeping an average of 8.2 hours and carers 7.8 hours per night . The objective assessment s revealed that although sleep efficiency ( SE ) was greater than 90 % for most patients and carers , sleep fragmentation was high in both groups . Patients and carers who complained of poor sleep were significantly more anxious ( P<0.001 and < 0.05 ) compared with patients and carers who reported sleeping well . Patients who complained of poor sleep had significantly more pain ( P<0.05 ) . These results show that a substantial proportion of advanced cancer patients and their carers complained of poor sleep despite reporting " normal " duration of sleep . Objective measurements using Actiwatch revealed good SE but high levels of sleep fragmentation and movement , suggesting that sleep quality may be disturbed . Further work is required to investigate sleep quality and the consequences of poor sleep . In the meantime , health care professionals need to routinely inquire about sleep and consider possible reversible underlying factors , such as pain and anxiety , for those who report sleep disturbance OBJECTIVES Caregivers of patients with various diseases frequently report sleep disturbances and depressive symptoms . Care intensity for individuals with Parkinson 's disease is mainly influenced by the severity of their motor impairment . The latter is associated with sleep fragmentation , nocturnal pain and cramps . These disease-specific characteristics contribute to sleep-related problems in patients . However , little is known about prevalence and causes of sleep disturbances in caregivers of Parkinson 's disease patients . DESIGN AND SETTING Cross-sectional analysis , nested within the FAQT- Study , a prospect i ve German cohort study evaluating determinants of quality of life in Parkinson 's disease patients . PARTICIPANTS We assessed 106 Parkinson 's disease patients and their caregiving partners . MEASUREMENTS Patients and partners were asked to fill in the Center for Epidemiologic Studies Depression Scale , the caregiver burden inventory , and the Giessener Beschwerdebogen of psychosomatic complaints . All instruments include questions about sleep related problems . Patients were examined by neurologists and classified according to established scales ( UPDRS and Hoehn and Yahr scales ) . RESULTS Frequent sleep disturbances were reported by 27 % of all spouses . Relevant depressive symptoms were shown in 30 % of spouses and 45 % of Parkinson 's disease patients ( P<0.001 ) . Depression scores in partners correlated with those in patients . Self-perceived bad night-time sleep in spouses was related to symptom severity , male gender , bad sleep in patients , and to the frequency of caregiving . Caregiver burden was identified as a mediator of the association between care intensity and bad sleep , while psychosomatic complaints were related to sleep problems independently . CONCLUSION Sleep disturbances are prevalent in partners of Parkinson 's disease patients and influenced by their engagement in the caregiving process . Treatment optimization for motor symptoms in patients may not only contribute to improved patient sleep but also to a lower prevalence of sleep disturbances in caregivers STUDY OBJECTIVES Although sleep curtailment has become widespread in industrialised societies , little work has examined the effects on mortality of change in sleep duration . We investigated associations of sleep duration and change in sleep duration with  all-cause , cardiovascular , and non-cardiovascular mortality .  DESIGN Prospect i ve cohort study . Data are from baseline ( Phase 1 , 1985 - 88 ) and Phase 3 ( 1991 - 93 ) , with mortality follow-up of 17 and 12 years respectively . SETTING The Whitehall II study of 10,308 white-collar British civil servants aged 35 - 55 at baseline . PARTICIPANTS 9781 participants with complete data were included in the analyses at Phase 1 , and 7729 of the same participants were included in the analyses at Phase 3 and the analyses of change in sleep duration . INTERVENTIONS None . MEASUREMENTS AND RESULTS U-shaped associations were observed between sleep ( < or = 5 , 6 , 7 , 8 , > or = 9 hours ) at Phase 1 and Phase 3 and subsequent all-cause , cardiovascular , and non-cardiovascular mortality . A decrease in sleep duration among participants sleeping 6 , 7 , or 8 hours at baseline was associated with cardiovascular mortality , hazard ratio 2.4 ( 95 % confidence intervals 1.4 - 4.1 ) . However , an increase in sleep duration among those sleeping 7 or 8 hours at baseline was associated with non-cardiovascular mortality , hazard ratio 2.1 ( 1.4 - 3.1 ) . Adjustment for the socio-demographic factors , existing morbidity , and health-related behaviours measured left these associations largely unchanged . CONCLUSIONS This is the first study to show that both a decrease in sleep duration and an increase in sleep duration are associated with an increase in mortality via effects on cardiovascular death and non-cardiovascular death respectively Background : Sleep disturbance may cause physical and psychological problems . The relationship between sleep disturbance and the burden of caregiving  among family caregivers ( FCs ) has not previously been investigated . Objective : The purpose s of this study were to ( 1 ) assess subjective and objective information on the sleep patterns of FCs of advanced cancer patients and ( 2 ) identify the components of caregiving burden that are risk factors for sleep disturbance among these FCs . Methods : A prospect i ve , cross-sectional study of 176 FCs was conducted .  Subjective and objective tools measuring sleep quality and caregiver burden  were used . A hierarchical regression model was applied to identify the predictive factors for sleep disturbance among FCs . Results : Approximately 72.2 % of FCs experienced sleep disturbance . The major sleep disturbance was frequent “ wake after sleep onset ” to provide patient care ; a nap during the day was necessary . Correlations were strong between caregiver burden and sleep quality . The final regression model , which included subjective and objective burden , predicted 56.6 % of the variance in sleep disturbance . Conclusions : Sleep disturbance was common in FCs of advanced cancer patient , and our results demonstrated the relationship between sleep disturbance and caregiving burden . Implication s for Practice : Family caregivers with risk factors for sleep disturbance should be identified and be provided re sources for sleep quality improvement PURPOSE / OBJECTIVES To evaluate outcomes of an intervention design ed to promote sleep and modify fatigue after adjuvant breast cancer chemotherapy . DESIGN Prospect i ve , repeated measures , quasi-experimental , feasibility study . SETTING Midwestern urban oncology clinics . SAMPLE 21 female participants , ages 43 - 66 years ( meanX = 55.3 ) with stage I or II breast cancer status post four cycles of doxorubicin chemotherapy .  Eight had four additional cycles of paclitaxel , 10 also had radiation , and 18 took tamoxifen . METHODS each woman continued to revise her Individualized Sleep Promotion Plan ( ISPP ) , developed during her first cycle of chemotherapy , that included sleep hygiene , relaxation therapy , stimulus control , and sleep restriction components . The  daily diary , Pittsburgh Sleep Quality Index , wrist actigraph , and Piper Fatigue Scale  were used for seven days 30 , 60 , and 90 days after the last chemotherapy treatment and one year after the first chemotherapy treatment . MAIN RESEARCH VARIABLES Adherence and sleep and wake , fatigue , and ISPP components . FINDINGS Adherence to the ISPP components remained high at all times ( 77%-88 % ) except for stimulus control ( 36%-56 % ) . Sleep outcome means and the actigraph revealed that ( a ) sleep latency remained less than 30 minutes per night , ( b ) the time awake after sleep onset exceeded the desired less than 30 minutes per night , ( c ) sleep efficiency scores ranged from 82%-92 % , ( d ) total rest time ranged from seven to eight hours per night , ( e ) feelings on arising ranged from 3.7 - 3.8 ( on a 0 - 5 scale ) , ( f ) nighttime awakenings ranged from 10 - 11 per night , and ( g ) daytime naps ranged from 10 - 15 minutes in length . Fatigue remained low , from 2.9 - 3.5 on a 0 - 10 scale . CONCLUSIONS Adherence rates remained high for most components . Sleep and wake patterns were within normal limits except for the number and duration of night awakenings . Fatigue remained low . IMPLICATION S FOR NURSING Future testing using an experimental design will focus on increasing ISPP adherence and decreasing nighttime awakenings . Adopting behavioral techniques to promote sleep may result in improved sleep and lower fatigue after chemotherapy Behavioral interventions that support caregivers ' restful sleep may delay the onset or decrease the severity of debilitating depressive symptoms . This , in turn , may increase caregivers ' physical and psychological health and wellbeing . A repeated- measures experimental design was used to test the feasibility and effectiveness of a brief behavioral sleep intervention for family caregivers of persons with advanced stage cancer . The CAregiver Sleep Intervention ( CASI ) includes stimulus control , relaxation , cognitive therapy , and sleep hygiene elements . CASI is individualized and delivered to accommo date caregiver burden . Thirty adult caregivers participated . The Pittsburgh Sleep Quality Index ( PSQI ) , Center for Epidemiological Studies -Depression scale ( CES-D ) , and Caregiver Quality of Life-Cancer scale ( CQOLC ) were used to measure self-reported sleep quality , depressive symptoms , and quality of life . Actigraphs measured latency , duration , efficiency , and wake after sleep onset ( WASO ) scores . Data were collected at baseline , 3 and 5 weeks , 2 , 3 , and 4 months post baseline . Improvement was seen across groups ; however , intervention caregivers showed more improvement in PSQI and CES-D scores than control caregivers . The CASI appears to be effective in improving sleep quality and depressive symptoms in caregivers of persons with cancer . Improvements in quality of life scores were similar across groups . Sample size and homogeneity limit generalizeability 
    Output:
    
First , at least 72 % of caregivers reported moderate to severe sleep disturbance as measured by the Pittsburgh Sleep Quality Index .
SIGNIFICANCE OF RESULTS Reduction in total sleep time appears to be the biggest issue facing caregivers ' sleep .