Electronic Theses and Dissertations

Date of Award


Document Type


Degree Name

Ph.D. in Pharmaceutical Sciences

First Advisor

Marie Barnard

Second Advisor

John P. Bentley

Third Advisor

Sujith Ramachandran

Relational Format



This dissertation aimed at filling gaps in the body of Parkinson’s disease (PD) and sleep literature by synthesizing and appraising current knowledge on the influence of sleep on health-related quality of life (HRQoL) in persons with Parkinson’s (PWP) and their caregivers, conducting a psychometric evaluation of a HRQoL instrument among PWP, and applying a novel method to assess the dyadic relationship between sleep and HRQoL in PWP and their caregivers. First, the systematic literature review results showed that nocturnal and diurnal sleep problems among PWP are strong predictors of their HRQoL. Additionally, studies that focused on caregiver outcomes showed that PWP and caregivers’ sleep issues were predictors of caregiver HRQoL. Results synthesized across these studies suggest that the relationship between sleep and HRQoL might be interdependent for PWP and caregivers. Second, a cross-sectional study was conducted to evaluate the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health, a generic HRQoL instrument, among PWP. Findings from this study provide evidence that the global physical health (GPH) and global mental health (GMH) summary scores obtained from this instrument show good reliability and validity in PWP. Finally, a cross-sectional study was conducted to assess the dyadic relationship between sleep and HRQoL among PWP and caregivers using the Actor-Partner Interdependence Model. This study used the PROMIS sleep disturbance (SD) and the PROMIS sleep-related impairment (SRI) to measure nocturnal and diurnal sleep issues, respectively. Results showed that both SD and SRI in PWP and their caregivers are significant predictors of their own HRQoL. Additionally, caregiver’s SD and SRI were found to be significant predictors of PWP’s HRQoL. These results provide empirical evidence that the sleep-HRQoL relationship is not an independently occurring phenomenon for PWP and caregivers. Study findings about the impact of sleep on HRQoL among PWP and their caregivers help provide a better understanding of this complex relationship in PD. Interventions aiming to improve PWP’s HRQoL might benefit from integrating services that also address caregivers’ sleep. Such interventions have the potential to reduce humanistic burden in this population and economic burden on the society by way of decreasing institutionalization rates among PWP.



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