REHABILITATION OF CIRCADIAN BLINDNESS IN OLDER PEOPLE

失明和衰老都经常与睡眠障碍有关。 对于哪些具有不良和潜在危险副作用的药物 通常都是处方药。对于盲人来说，这些睡眠障碍可能 是由于内源性昼夜节律起搏器和其 与睡眠-唤醒时间表有关的输出，因为它们缺少 生物钟携带所需的周期性光输入 一天24小时。如果没有这样的光输入，盲人的昼夜节律 个体可能在内生昼夜节律的一段时间内“自由奔跑” 起搏器，接近24小时，但不同于24小时。在这些免费的- 盲人跑步时，可能会有慢性睡眠和昼夜节律 严重程度随相对关系而变化的扰动 睡眠/唤醒周期和内部时钟。随着年龄的增长，有一个 失明的增加，因此这种残疾的流行。 在这项研究提案中，我计划对失明的老年人进行研究以验证 自由奔跑的昼夜节律的存在，然后用 褪黑素，一种内源性激素，既能缓解慢性睡眠 当他们保持24小时时间表时出现的问题并进行改进 在接下来的清醒时间内的认知表现。具体来说，我 计划测试以下假设：(1)大多数老年盲人患者 如果没有有意识的光感知，就不能同步他们的 昼夜节律起搏器到24小时；(2)光输入到 这些盲人的下丘脑和松果体功能缺失； 非视觉认知和心理测量性能下降，以及 这些盲人的睡眠、内分泌和代谢异常 人；和(4)睡前服用生理剂量的 褪黑素将改善睡眠、认知和精神运动表现 措施。 每个较老的盲人科目都将被研究几次，首先要确定 存在自由奔跑的昼夜节律和相关的紊乱， 然后在使用褪黑激素治疗期间验证睡眠改善情况 变量，如睡眠延迟和睡眠效率，以及认知和 绩效衡量标准。 结果将适用于盲人社区和老年人 有或没有视力或光线暴露问题的人群，以及 对于非24小时计划的年轻人，例如 轮班工作或夜班工作时间表。改善睡眠和 这一大部分人口的绩效衡量标准 天然荷尔蒙的生理量而不是药理学剂量 具有潜在危险副作用的药物有可能 恢复和改善许多个人和他们的生活 家人。

Both blindness and aging are frequently associated with sleep disturbances for which medicines with undesired and potentially dangerous side effects are often prescribed. In blind individuals, these sleep disturbances may be due to misalignment of the endogenous circadian pacemaker and its outputs with respect to the sleep-wake schedule, for they lack the periodic light input necessary for entrainment of the circadian clock to the 24 hour day. Without such light input, circadian rhythms of blind individuals may "free-run" at a period of the endogenous circadian pacemaker which is near-to but different from 24.00 hours. In these free- running blind people, there may be a chronic sleep and circadian rhythm disturbance whose severity varies with the relative relationship between the sleep/wake cycle and the internal clock. With aging, there is an increase in blindness and therefore the prevalence of this disability. In this research proposal, I plan to study blind older people to verify the presence of free-running circadian rhythms and then treat them with melatonin, an endogenous hormone, both to alleviate the chronic sleep problems that occur when they maintain a 24-hour schedule and to improve cognitive performance during the following waking hours. Specifically, I plan to test the hypotheses that (1) the majority of older blind patients without conscious light perception are unable to synchronize their circadian pacemakers to the 24-hour day; (2) light input to the hypothalamus and pineal is functionally absent in these blind people; (3) non-visual cognitive and psychometric performance decrements, as well as sleep, endocrine and metabolic abnormalities are found in these blind people; and (4) pre-sleep administration of physiological doses of melatonin will improve sleep, cognitive and psychomotor performance measures. Each older blind subject will be studied several times, first to establish the presence of free-running circadian rhythms and associated disorders, then during treatment with melatonin to verify improvement of sleep variables, such as sleep latency and sleep efficiency, and cognitive and performance measures. The results will be applicable to the blind community, to the older population with and without vision or light exposure problems, as well as to younger individuals on non-24 hour schedules, such as people on rotating shift work or night work schedules. Improving the sleep and performance measures of this large segment of the population using physiologic amounts of a natural hormone rather than pharmacological doses of medicines with potentially dangerous side effects has the potential to rehabilitate and improve the lives of the many individuals and their families.