EFFECT OF ACTIVITIES AND EXERCISE ON SLEEP IN DEMENTIA

活动和锻炼对痴呆症患者睡眠的影响

• 批准号: 7377673
• 负责人: Kathy Culpepper Richards
• 金额: $ 2.66万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-01 至 2007-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7377673
• 关键词: EFFECT; ACTIVITIES; EXERCISE; SLEEP; DEMENTIA

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. While investigators have examined the effects of increasing social or physical activities or both on sleep in elders in nursing homes and assisted living facilities, one study lacked a control group or tests of significance, another was conducted in an assisted living facility as opposed to a nursing home and included only cognitively-intact participants who are much easier to engage in social activities and exercise, and the other studied only incontinent residents. In the only study that did not find an improvement in the sleep of residents after an exercise program, the exercise may have been of insufficient duration (both minutes per day and length of the intervention period) and intensity. Prolonged bedrest, fear of falling, and dependency in activities of daily living result in declining muscle strength in residents. As we have demonstrated, this declining muscle strength leads to further physical inactivity and sleep disturbance. We have shown that high intensity PRT is safe, feasible, and markedly increased muscle strength and physical activity in residents with CI. The literature supports our hypothesis that increased daytime physical activity will directly improve nighttime sleep and indirectly improve nighttime sleep by decreasing daytime napping. Future outcome studies require more precise measures of sleep. Other investigators have used actigraphy 31,32 or observations by nursing home staff. The only study that measured sleep using polysomnography occurred in an assisted living facility with cognitively intact elders. Polysomnography, the gold standard for sleep measurement, precisely measures nocturnal total sleep time and sleep stages. Investigators have conducted descriptive studies of sleep in CI elders using polysomnography, but no one to our knowledge has measured the efficacy of an intervention using it. Although actigraphy and observation are better tolerated in CI elders than polysomnography, only polysomnography can provide information on the effects of the intervention on important variables that affect sleep quality such as sleep stages. For example, consistent effects of exercise on stages 2, 3 and 4 NREM sleep in young adults would have remained undetected if researchers had only used actigraphy or observation to measure sleep. The literature supports our hypothesis that the proposed ISA and PRT will each increase nocturnal total sleep time and sleep-wake rhythm amplitude. Further, combining ISA and PRT will result in the greatest improvement in nighttime total sleep time and sleep-wake rhythm amplitude because they will each increase the homeostatic sleep drive, and they will each increase circadian pacemaker entrainment. No other team has investigated the effect of high intensity PRT on sleep in elders with CI. Further, no other research team has targeted residents with disturbed sleep. This is extremely important because conducting an intervention for every resident, or even every incontinent resident, is too costly and unlikely for nursing home staffs to implement. We have shown that ISA reduces excessive daytime sleep and may improve nighttime sleep in residents with CI, but our findings were inconclusive. Further testing with more sensitive instrumentation is indicated. We propose to use polysomnography to more precisely reflect total sleep time.

该子项目是利用 NIH/NCRR 资助的中心拨款提供的资源的众多研究子项目之一。子项目和研究者 (PI) 可能已从另一个 NIH 来源获得主要资金，因此可以在其他 CRISP 条目中得到体现。列出的机构是中心的机构，不一定是研究者的机构。虽然研究人员研究了增加社交或体力活动或两者兼而有之对疗养院和辅助生活设施中老年人睡眠的影响，但一项研究缺乏对照组或显着性测试，另一项研究是在辅助生活设施而不是护理机构中进行的在家中，仅包括认知功能完整的参与者，他们更容易参与社交活动和锻炼，而另一个则仅研究失禁居民。在唯一一项没有发现锻炼计划后居民睡眠有所改善的研究中，锻炼的持续时间（每天的分钟数和干预期的长度）和强度可能不足。 长时间卧床、害怕跌倒以及对日常生活活动的依赖会导致居民的肌肉力量下降。正如我们所证明的，这种肌肉力量的下降会导致进一步的身体活动不足和睡眠障碍。我们已经证明，高强度 PRT 是安全、可行的，并且可以显着增加 CI 居民的肌肉力量和体力活动。文献支持我们的假设，即增加白天的体力活动将直接改善夜间睡眠，并通过减少白天小睡间接改善夜间睡眠。 未来的结果研究需要更精确的睡眠测量。其他调查人员使用了体动记录仪 31,32 或疗养院工作人员的观察结果。唯一一项使用多导睡眠图测量睡眠的研究是在辅助生活设施中进行的，其中老年人的认知功能完好。 多导睡眠图是睡眠测量的金标准，可精确测量夜间总睡眠时间和睡眠阶段。研究人员使用多导睡眠图对 CI 老年人的睡眠进行了描述性研究，但据我们所知，没有人测量过使用它进行干预的效果。尽管体动记录法和观察法在 CI 老年人中比多导睡眠图更容易耐受，但只有多导睡眠图才能提供有关干预措施对影响睡眠质量的重要变量（如睡眠阶段）的影响的信息。例如，如果研究人员仅使用体动记录仪或观察来测量睡眠，则运动对年轻人 NREM 睡眠第 2、3 和 4 阶段的持续影响将无法被发现。 文献支持我们的假设，即所提出的 ISA 和 PRT 将分别增加夜间总睡眠时间和睡眠-觉醒节律幅度。此外，结合 ISA 和 PRT 将最大程度地改善夜间总睡眠时间和睡眠-觉醒节律幅度，因为它们都会增加稳态睡眠驱动，并且它们都会增加昼夜节律起搏器夹带。没有其他团队研究过高强度 PRT 对患有 CI 的老年人睡眠的影响。此外，没有其他研究团队针对睡眠障碍的居民。这非常重要，因为对每个居民，甚至每个失禁的居民进行干预，成本太高，疗养院工作人员不太可能实施。我们已经表明，ISA 可以减少 CI 患者白天过度睡眠的情况，并可能改善夜间睡眠，但我们的研究结果尚无定论。表明需要使用更灵敏的仪器进行进一步测试。我们建议使用多导睡眠图更准确地反映总睡眠时间。