Sleep/Cognitive Performance/Older Adults/Insomnia

描述（由申请人提供）：在65岁及以上的人群中，高达35%的人患有失眠症。尽管老年失眠症（OAWI）患者经常抱怨认知功能受损，但这种损害的客观证据很少。然而，最近，一些相关研究发现了OAWI患者认知表现缺陷的证据。不幸的是，由于典型的相关设计采用“一次性”评估，这些研究只提供了睡眠/认知关系的“快照”。这种方法可以改进，因为睡眠和认知表现可能表现出相当大的日常变化，特别是在老年人中。通过重复的日常评估，这些睡眠和认知的波动（个体内变异性或IIV）可以被捕获和建模。由于睡眠被认为在皮质恢复中发挥作用，因此假设睡眠的可变性将预测认知表现的可变性。在拟议的研究中，OAWI将在失眠的标准行为治疗计划的整个过程中完成每日日记（睡眠和认知）。这项研究特别具有创新性，因为它将首次在干预设计的背景下采用每日日记方法和IIV建模的最新进展。这种新颖的设计/方法结合将为OAWI中睡眠/认知关系提供独特的见解，因此将为睡眠和认知领域做出宝贵的贡献。

DESCRIPTION (provided by applicant): Insomnia affects up to 35 percent of individuals aged 65 and older. Although older adults with insomnia (OAWI) frequently complain of impaired cognitive functioning, objective evidence of such impairment has been sparse. Recently, however, a handful of correlational studies have found evidence of deficits in cognitive performance in OAWI. Unfortunately, because the typical correlational design utilizes 'one shot' assessments, these studies provide only a 'snapshot' of the sleep/cognition relationship. This approach could be improved as both sleep and cognitive performance may exhibit considerable day-to-day variability, particularly in older adults. Using repeated daily assessments, these fluctuations in sleep and cognition (intraindividual variability or IIV) can be captured and modeled. Because sleep is believed to play a role in cortical recovery, it is hypothesized that variability in sleep will predict variability in cognitive performance. In the proposed study, OAWI will complete daily diaries (sleep & cognitive) throughout the course of a standard behavioral treatment program for insomnia. This study is particularly innovative, because it will be the first to employ daily diary methodology and recent advances in IIV modeling in the context of an intervention design. This novel design/methodology combination will provide unique insights into the sleep/cognition relationship in OAWI and as a result, will make valuable contributions to the fields of sleep and cognition. The two (2) specific aims of this project and their associated subaims are: Aim 1: To confirm the effects of sleep treatment on sleep outcomes, and to explore transfer of sleep intervention to cognition. Subaim 1.1: To investigate influence of sleep treatment on pre-post changes in sleep and cognition. Subaim 1.2: To investigate changes in sleep and cognitive intraindividual variability as a consequence of insomnia treatment. Aim 2: To investigate the dynamic relationship between sleep and cognition over time. Subaim 2.1: To investigate concurrent associations between level and variability in sleep and cognition. Subaim 2.2: To investigate lagged relationships between level and variability in sleep and cognition. Subaim 2.3: To investigate whether there exist homogeneous subgroups with varying patterns of sleep-cognition relationships. This study is not a treatment efficacy study per se. Previous research has already shown behavioral treatment to be effective for late-life insomnia. The success of the proposed treatment will be evaluated, however, and comparisons in IIV in cognitive functioning and sleep between successfully treated and untreated individuals will be made (see Specific Aim 1).