DREAMS-START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives) for people with dementia and sleep disturbances: a single-blind feasibility and acceptability randomized controlled trial
DREAMS-START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives) for people with dementia and sleep disturbances: a single-blind feasibility and acceptability randomized controlled trial
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DOI：
10.1017/s1041610218000753
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发表时间：
2019-02-01
影响因子：
7
通讯作者：
Rapaport, Penny
中科院分区：
文献类型：
--
作者：
Livingston, Gill;Barber, Julie A.;Rapaport, Penny
背景：40%的痴呆症患者有睡眠障碍，但目前还没有已知的有效治疗方法。睡眠卫生和光疗法的研究还没有足够的动力来表明可行性和可接受性，并显示40-50%的保留。我们测试了六次会议的手动循证非药物治疗的可行性和可接受性;痴呆症相关睡眠手册;睡眠障碍的相关性研究（DREAMS-START）。方法：我们进行了一项平行、双组、单盲随机试验，并以2：1的比例随机分为干预组：治疗组。符合条件的参与者患有痴呆症和睡眠障碍（在一项睡眠障碍调查中得分>= 4），并有一名家庭照顾者，他们是从两个伦敦记忆服务中心和联合痴呆症研究中心招募的。参与者在随机分组前佩戴actiwatch两周。经过培训，临床监督的心理学毕业生向随机接受干预的护理人员提供了DREAMS-START;涵盖了解睡眠和痴呆症;制定计划（将actiwatch信息，使用灯箱曝光）;白天活动和日常活动;困难的夜间行为;照顾自己（护理人员）的睡眠;以及什么有效？未来战略。护理人员保留了干预后的手册、灯箱和放松记录。结局评估对分配设盲。共同主要结果是可行性（>= 50%的合格人员同意研究）和可接受性（>= 75%的干预组参加>= 4次干预会议）。结果如下：总体而言，在2016年4月8日至2017年3月24日期间，95名合格转诊患者中有63名（66%; 95% CI：56-76%）同意接受治疗; 62名（65%; 95% CI：55-75%）接受随机化，42名患者中有37名（88%; 95% CI：75-96%）坚持接受干预。结论：DREAM-START治疗痴呆患者睡眠障碍是可行的和可接受的。
Background: 40% of people with dementia have disturbed sleep but there are currently no known effective treatments. Studies of sleep hygiene and light therapy have not been powered to indicate feasibility and acceptability and have shown 40-50% retention. We tested the feasibility and acceptability of a six-session manualized evidence-based non-pharmacological therapy; Dementia RElAted Manual for Sleep; STrAtegies for RelaTives (DREAMS-START) for sleep disturbance in people with dementia. Methods: We conducted a parallel, two-armed, single-blind randomized trial and randomized 2:1 to intervention: Treatment as Usual. Eligible participants had dementia and sleep disturbances (scoring >= 4 on one Sleep Disorders Inventory item) and a family carer and were recruited from two London memory services and Join Dementia Research. Participants wore an actiwatch for two weeks pre-randomization. Trained, clinically supervised psychology graduates delivered DREAMS-START to carers randomized to intervention; covering Understanding sleep and dementia; Making a plan (incorporating actiwatch information, light exposure using a light box); Daytime activity and routine; Difficult night-time behaviors; Taking care of your own (carer's) sleep; and What works? Strategies for the future. Carers kept their manual, light box, and relaxation recordings post-intervention. Outcome assessment was masked to allocation. The co-primary outcomes were feasibility (>= 50% eligible people consenting to the study) and acceptability (>= 75% of intervention group attending >= 4 intervention sessions). Results: In total, 63out of 95 (66%; 95% CI: 56-76%) eligible referrals consented between 04/08/2016 and 24/03/2017; 62 (65%; 95% CI: 55-75%) were randomized, and 37 out of 42 (88%; 95% CI: 75-96%) adhered to the intervention. Conclusions: DREAM-START for sleep disorders in dementia is feasible and acceptable.