Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial.
Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial.
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DOI：
10.1001/jamainternmed.2014.8081
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发表时间：
2015-04
影响因子：
39
通讯作者：
Irwin, Michael R.
中科院分区：
文献类型：
--
作者：
Black, David S.;O'Reilly, Gillian A.;Olmstead, Richard;Breen, Elizabeth C.;Irwin, Michael R.
睡眠障碍在老年人中最为普遍，而且往往得不到治疗。治疗睡眠障碍的方法仍然有限，因此有必要开展社区可及的项目来改善睡眠。确定一种名为正念冥想的身心医学干预方法在改善中度睡眠障碍老年人睡眠质量方面的功效。2012年1月1日至12月31日，在某医学研究中心对中度睡眠障碍（匹兹堡睡眠质量指数[PSQI] bbbb5）的老年成人（平均[SD]年龄66.3[7.4]岁）进行了两组随机临床试验。标准化正念意识练习（MAPs）干预（n = 24）或睡眠卫生教育（SHE）干预（n = 25）随机分配给参与者，他们接受为期6周的干预（每周2小时），并分配作业。该研究通过干预后的PSQI来检测中度睡眠障碍的组间差异。次要结果与睡眠相关的日间损害有关，包括失眠症状、抑郁、焦虑、压力和疲劳的有效测量，以及通过核因子(NF) -κB的炎症信号。使用意向治疗分析，map组的参与者在PSQI上相对于SHE组表现出显著的改善。在MAPs干预下，基线时PSQIs均值（SD）为10.2(1.7)，干预后为7.4（1.9）。在SHE干预下，基线时PSQIs均值（SD）为10.2(1.8)，干预后为9.1（2.0）。组间平均差异为1.8 (95%CI, 0.6-2.9)，效应量为0.89。与SHE组相比，map组在失眠症状、抑郁症状、疲劳干扰和疲劳严重程度等次要健康指标上均有显著改善（P < 0.05）。两组间焦虑、应激或NF-κB均无差异，但两组的NF-κB浓度均随时间显著下降（P < 0.05）。使用社区可访问的map干预在干预后立即改善了睡眠质量，优于高度结构化的SHE干预。正式的正念干预具有临床重要性，因为它可能在短期内修复老年人的睡眠问题，而且这种效果似乎可以延续到减少与睡眠有关的白天损害，这对生活质量有影响。clinicaltrials.gov标识符：NCT01534338
Sleep disturbances are most prevalent among older adults and often go untreated. Treatment options for sleep disturbances remain limited, and there is a need for community-accessible programs that can improve sleep. To determine the efficacy of a mind-body medicine intervention, called mindfulness meditation, to promote sleep quality in older adults with moderate sleep disturbances. Randomized clinical trial with 2 parallel groups conducted from January 1 to December 31, 2012, at a medical research center among an older adult sample (mean [SD] age, 66.3 [7.4] years) with moderate sleep disturbances (Pittsburgh Sleep Quality Index [PSQI] >5). A standardized mindful awareness practices (MAPs) intervention (n = 24) or a sleep hygiene education (SHE) intervention (n = 25) was randomized to participants, who received a 6-week intervention (2 hours per week) with assigned homework. The study was powered to detect between-group differences in moderate sleep disturbance measured via the PSQI at postintervention. Secondary outcomes pertained to sleep-related daytime impairment and included validated measures of insomnia symptoms, depression, anxiety, stress, and fatigue, as well as inflammatory signaling via nuclear factor (NF)–κB. Using an intent-to-treat analysis, participants in the MAPs group showed significant improvement relative to those in the SHE group on the PSQI. With the MAPs intervention, the mean (SD) PSQIs were 10.2 (1.7) at baseline and 7.4 (1.9) at postintervention. With the SHE intervention, the mean (SD) PSQIs were 10.2 (1.8) at baseline and 9.1 (2.0) at postintervention. The between-group mean difference was 1.8 (95%CI, 0.6–2.9), with an effect size of 0.89. The MAPs group showed significant improvement relative to the SHE group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity (P < .05 for all). Between-group differences were not observed for anxiety, stress, or NF-κB, although NF-κB concentrations significantly declined over time in both groups (P < .05). The use of a community-accessible MAPs intervention resulted in improvements in sleep quality at immediate postintervention, which was superior to a highly structured SHE intervention. Formalized mindfulness-based interventions have clinical importance by possibly serving to remediate sleep problems among older adults in the short term, and this effect appears to carry over into reducing sleep-related daytime impairment that has implications for quality of life. clinicaltrials.gov Identifier: NCT01534338
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影响因子：
5
作者：
COHEN, S;KAMARCK, T;MERMELSTEIN, R
通讯作者：
MERMELSTEIN, R
影响因子：
5.9
作者：
Hofmann, Stefan G.;Sawyer, Alice T.;Witt, Ashley A.;Oh, Diana
通讯作者：
Oh, Diana
影响因子：
3.3
作者：
Britton, Willoughby B.;Haynes, Patricia L.;Bootzin, Richard R.
通讯作者：
Bootzin, Richard R.
影响因子：
4.7
作者：
Backhaus, J;Junghanns, K;Hohagen, F
通讯作者：
Hohagen, F
影响因子：
3.4
作者：
Beck, AT;Steer, RA;Ranieri, WF
通讯作者：
Ranieri, WF