AGE RELATED SLEEP IMPAIRMENT--POSSIBLE INTERVENTIONS

这是Michael V.Vitiello博士的NIMH独立科学家奖K02-MH01158的竞争更新，与年龄相关的睡眠障碍可能的干预。多达40%的老年人抱怨严重的、长期的睡眠障碍。睡眠问题经常导致长期使用镇静剂和催眠药，老年人收到的此类处方数量不成比例。镇静-催眠药提供短期缓解，但其长期疗效尚不清楚，长期使用与增加发病率和死亡率有关。美国国立卫生研究院最近的一次共识会议得出结论，长期使用催眠药是不合适的，迫切需要对睡眠中断进行非镇静干预。维蒂洛博士提出了三个具体目标，以研究可能的非镇静催眠方法来改善老年人的睡眠质量：具体目标1：检查健身训练干预措施改善老年男性和女性睡眠质量的有效性。具体目标2：检查神经内分泌干预(例如，生长激素释放激素、雌激素和睾酮补充)改善老年男性和女性睡眠质量的有效性。具体目标3：研究认知行为技术在多种不同环境下改善老年男性和女性睡眠质量的有效性。在追求这些目标的同时，维蒂洛博士还将在性激素与睡眠质量的相互作用、睡眠和呼吸的动态监测、休息/活动节律的动态记录以及老年人睡眠障碍的认知行为干预方面发展更多的专业知识。每一条建议的研究路线对于我们理解老年人睡眠障碍的原因和潜在的治疗方法都具有相当大的意义。有效的非镇静干预不仅可以显著改善老年人的睡眠质量，而且还可以显著提高老年人的整体生活质量。此外，这些干预措施可能会对降低与这种睡眠障碍或长期催眠药物不适当治疗直接相关的发病率和死亡率产生重大影响。

This is a competing renewal of Dr. Michael V. Vitiello's NIMH Independent Scientist Award, K02-MH01158, Age-Related Sleep Disturbance Possible Interventions. As much as 40% of the older population complains of significant, chronic sleep disturbance. Sleep complaints often lead to chronic sedative hypnotic use and the elderly receive a disproportionate number of such prescriptions. Sedative-hypnotics offer short-term relief but their long-term efficacy is unclear and chronic use has been associated with increased morbidity and mortality. A recent NIH Consensus Conference concluded that chronic hypnotic use is inappropriate and that non-sedative interventions for sleep disruption are sorely needed. Dr. Vitiello proposes three specific aims that will examine possible non-sedative hypnotic approaches to improving the sleep quality of the elderly: Specific Aim 1: Examine the usefulness of fitness training interventions to improve the sleep quality of older men and women. Specific Aim 2: Examine the usefulness of neuroendocrine interventions (e.g., growth hormone releasing hormone, estrogen, and testosterone supplementation) to improve the sleep quality of older men and women. Specific Aim 3: Examine the usefulness of cognitive behavioral techniques to improve the sleep quality of older men and women in a number of different settings. While pursuing these aims, Dr. Vitiello will develop additional expertise in the interactions of sex steroids and sleep quality, ambulatory monitoring of sleep and respiration, actigraphic recording of rest/activity rhythms and cognitive behavioral interventions for sleep disturbance in the elderly. Each of these proposed lines of research has considerable significance for our understanding of the causes of,and potential treatments for, sleep disturbance in the aged. Effective non- sedative interventions may significantly improve not only sleep quality but also overall the quality of life in the elderly. Further, such interventions may have significant impact in decreasing morbidity and mortality directly related to such sleep disturbance or its inappropriate treatment with chronic hypnotic medications.