Improved sleep quality in older adults with insomnia reduces biomarkers of disease risk: pilot results from a randomized controlled comparative efficacy trial.
Improved sleep quality in older adults with insomnia reduces biomarkers of disease risk: pilot results from a randomized controlled comparative efficacy trial.
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DOI：
10.1016/j.psyneuen.2015.02.010
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发表时间：
2015-05
影响因子：
3.7
通讯作者：
Irwin, Michael R.
中科院分区：
文献类型：
--
作者：
Carroll, Judith E.;Seeman, Teresa E.;Olmstead, Richard;Melendez, Gerson;Sadakane, Ryan;Bootzin, Richard;Nicassio, Perry;Irwin, Michael R.
睡眠障碍与发病率和死亡率的增加有关，然而，目前尚不清楚改善老年失眠患者的睡眠质量是否会改变糖尿病和心血管疾病风险的生物标志物。确定认知行为疗法(CBT)、太极拳(TCC)和睡眠研讨会对照(SS)在降低患有失眠的老年人疾病风险的多系统生物标志物方面的比较有效性。随机对照比较疗效试验。洛杉矶社区以人群为基础的样本，包括109名患有慢性和原发性失眠的老年人，随机分配到CBT、TCC或SS，在4个月内每周进行2小时的小组会议，并进行16个月的评估(随访后1年)。多系统生物风险包括8个生物标志物：高密度脂蛋白、低密度脂蛋白、甘油三酯、血红蛋白A1c、葡萄糖、胰岛素、C反应蛋白和纤维蛋白原。使用定义为异常的临床实验室临界值，计算多系统风险评分，代表8个生物标志物临界值的偏差总和。此外，如果受试者在异常实验室范围内表现出4个或更多生物标志物，则将高危分组归类。高危人群治疗时间的交互作用(F(4,197.2)=3.14，p=.02)，其中16个月时TCC(p=.04)和CBT(p=.001)的风险评分均显著低于SS。CBT降低了出生4个月(优势比[OR]=.21[95%CI，0.03-1.47]，P<；.10)和16个月(OR=0.06[95%CI，.005-.669]；P<；.01)处于高风险组的风险。TCC在16个月时降低了风险(OR=.10[95%CI，.008-1.29]；p<；0.05)，但在4个月时不降低风险。在基线被归类为高风险类别的参与者中，睡眠质量的改善(由临床严重程度阈值定义)在16个月时降低了进入高风险组的可能性，OR=0.08(95%CI，0.008-0.78)；p=0.01。被归类为进入时具有高多系统生物风险并被分配到CBT或TCC的参与者在一年后的随访中显示出风险得分的改善。鉴于这些临床生物标记物与心血管、代谢和炎症性疾病的风险相关，改善睡眠质量有可能降低患有失眠的老年人患慢性病的风险。临床试验.gov：NCT00280020，老年失眠的行为治疗
Sleep disturbances have been linked to increased morbidity and mortality, yet it is unknown whether improving sleep quality in older adult patients with insomnia alters biomarkers of diabetes and cardiovascular disease risk. Determine the comparative efficacy of cognitive behavioral therapy (CBT), tai chi chih (TCC), and a sleep seminar control (SS) to reduce multisystem biomarkers of disease risk in older adults with insomnia. Randomized controlled comparative efficacy trial. Los Angeles community A population-based sample of 109 older adults with chronic and primary insomnia Random assignment to CBT, TCC, or SS for 2-hour group sessions weekly over 4 months with a 16-month evaluation (1 year after follow-up). Multisystem biological risk comprised of 8 biomarkers: high-density lipoprotein, low-density lipoprotein, triglycerides, hemoglobinA1c, glucose, insulin, C-reactive protein, and fibrinogen. Using clinical laboratory cutoffs defined as abnormal, a multisystem risk score was computed representing a sum of the deviation around the cutoffs across the 8 biomarkers. In addition, high risk grouping was classified if subjects exhibited 4 or more biomarkers in the abnormal laboratory range. An interaction of time-by-treatment-by-high risk group was found (F(4,197.2)=3.14, p=.02) in which both TCC (p=.04) and CBT (p=.001) showed significantly lower risk scores as compared to SS at 16-months. CBT reduced risk of being in the high risk group at 4-months (odds ratio [OR]=.21 [95%CI, .03–1.47], p<.10) and at 16-months (OR=0.06 [95%CI, .005–.669]; p<.01). TCC reduced the risk at 16-months (OR=.10 [95%CI, .008–1.29]; p<.05) but not at 4 months. Of participants who were classified in the high risk category at baseline, improvements in sleep quality, as defined by a clinical severity threshold, reduced the likelihood of being in the high risk group at 16-months, OR=.08 (95% CI, .008–.78); p = .01. Participants classified as having high multisystem biological risk at entry and assigned to CBT or TCC show improvements in risk scores after one year follow-up. Given that these clinical biomarkers are associated with cardiovascular, metabolic, and inflammatory disease risk, improving sleep quality has the potential to reduce the risk of chronic disease in older adults with insomnia. ClinicalTrials.gov: NCT00280020, Behavioral Treatment of Insomnia in Aging
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DOI：
10.1073/pnas.1315458110
发表时间：
2013-10-15
影响因子：
11.1
作者：
Carroll, Judith E.;Gruenewald, Tara L.;Seeman, Teresa E.
通讯作者：
Seeman, Teresa E.
影响因子：
5.6
作者：
Irwin, Michael R.;Olmstead, Richard;Nicassio, Perry
通讯作者：
Nicassio, Perry
影响因子：
5.6
作者：
Chen, Xiaoli;Redline, Susan;Williams, Michelle A.
通讯作者：
Williams, Michelle A.
影响因子：
5.6
作者：
Haack, Monika;Sanchez, Elsa;Mullington, Janet M.
通讯作者：
Mullington, Janet M.
影响因子：
3.7
作者：
Cizza G;Piaggi P;Rother KI;Csako G;Sleep Extension Study Group
通讯作者：
Sleep Extension Study Group