Abstract Introduction Care partners (CPs) are often asked to identify sleep deficiency among persons with cognitive impairment (PwCI). We identified themes associated with agreement between CP reports and objective measures of sleep in PwCIs. Methods We conducted a convergent mixed methods study among 11 dyads with simultaneous collection of semi-structured qualitative interviews among CPs, CP-reported quantitative sleep characteristics for PwCIs, and objective measures of sleep from electroencephalography-measuring headbands in PwCIs. Following interviews, PwCIs wore headbands for seven nights. Comparing CP-reported total sleep time (TST) to average objective TST, we grouped dyads into: (1) agreement ( 1-hour difference), (2) overreporting (CP report ≥1 hour more), and (3) underreporting (CP report ≥1 hour less). Two coders conducted inductive thematic analysis of interview transcripts to identify themes within each group. Results In the agreement group (N=4), routine sleep-related communication, often initiated spontaneously by the PwCI, appeared across the interviews. CPs expressed high trust in PwCI self-report and said that sleep disturbances in PwCI did not affect them. Notably, sleeping apart or having misaligned sleep patterns did not necessarily compromise agreement. In the overreporting group (N=4), CPs frequently believed PwCI were unaware of their own sleep but nevertheless relied on PwCI self-report. Communication about sleep within the dyad was less important in this group, while complaints about excessive sleep or napping were frequently identified. CPs in this group generally viewed sleep issues as less concerning than what PwCIs perceived. In the underreporting group (N=3), CPs described limited direct observation and low confidence in PwCI self-report. Sleep complaints centered on frequent nighttime awakenings and insomnia symptoms. Medication use in PwCIs emerged only in this group. Emotional distress related to caregiving, disease progression, or dyads’ relationships was prominent in this group. Conclusion Communication frequency, trust in PwCI self-report, and the perceived sleep disturbances meaningfully shape CP proxy reports. Overreporting appears linked to perceptions of excessive sleep and minimal concern about sleep problems, whereas underreporting is connected to insomnia-like symptoms, limited observation, and emotional distress. These patterns highlight clinical situations in which objective evaluation of sleep in PwCIs may be needed. Support (if any)
Huo et al. (Fri,) studied this question.