EFFECT OF ACTIVITIES AND EXERCISE ON SLEEP IN DEMENTIA

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。虽然研究人员研究了养老院和辅助生活设施中增加的社交或身体活动或两者都对老年人睡眠的影响，但有一项研究缺乏对照组或有意义的测试，另一项研究是在辅助生活设施而不是疗养院进行的，只包括认知正常的参与者，他们更容易参与社会活动和锻炼，另一项研究只研究了大小便失禁的居民。在唯一一项没有发现锻炼计划后居民睡眠得到改善的研究中，锻炼的持续时间(每天的分钟数和干预期的长度)和强度可能不足。长期卧床、害怕摔倒、对日常生活活动的依赖导致居民肌力下降。正如我们已经证明的，这种肌肉力量的下降会导致进一步的身体不活动和睡眠障碍。我们已经证明，高强度PRT是安全、可行的，并显著增加CI患者的肌力和体力活动。文献支持我们的假设，即增加白天的体力活动将直接改善夜间睡眠，并通过减少白天的午睡间接改善夜间睡眠。未来的结果研究需要更精确的睡眠测量。其他调查人员使用了动作记录仪31、32或疗养院工作人员的观察。唯一一项使用多导睡眠图测量睡眠的研究是在认知完好的老年人辅助生活设施中进行的。多导睡眠图是睡眠测量的黄金标准，它精确地测量夜间总睡眠时间和睡眠阶段。研究人员已经使用多导睡眠图对CI老年人的睡眠进行了描述性研究，但据我们所知，没有人使用它来衡量干预的效果。尽管与多导睡眠图相比，脑梗塞老年人更容易接受活动和观察，但只有多导睡眠图才能提供有关干预对影响睡眠质量的重要变量(如睡眠阶段)影响的信息。例如，如果研究人员只使用动作记录仪或观察来测量睡眠，那么运动对年轻人第二、第三和第四阶段NREM睡眠的一致影响将仍然没有被检测到。文献支持我们的假设，即拟议的ISA和PRT都会增加夜间总睡眠时间和睡眠-觉醒节律幅度。此外，ISA和PRT联合应用将使夜间总睡眠时间和睡眠-觉醒节律幅度得到最大程度的改善，因为它们都会增加动态平衡睡眠驱动力，它们都会增加昼夜起搏器的携带。没有其他团队研究高强度PRT对患有脑梗塞的老年人睡眠的影响。此外，没有其他研究团队针对睡眠障碍的居民。这一点非常重要，因为对每一位居民，甚至是每一位大小便失禁的居民进行干预，成本太高，而且不太可能由疗养院工作人员实施。我们已经证明，ISA减少了白天的过度睡眠，并可能改善CI患者的夜间睡眠，但我们的发现并不确定。建议进一步使用更灵敏的仪器进行测试。我们建议使用多导睡眠图来更准确地反映总睡眠时间。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. While investigators have examined the effects of increasing social or physical activities or both on sleep in elders in nursing homes and assisted living facilities, one study lacked a control group or tests of significance, another was conducted in an assisted living facility as opposed to a nursing home and included only cognitively-intact participants who are much easier to engage in social activities and exercise, and the other studied only incontinent residents. In the only study that did not find an improvement in the sleep of residents after an exercise program, the exercise may have been of insufficient duration (both minutes per day and length of the intervention period) and intensity. Prolonged bedrest, fear of falling, and dependency in activities of daily living result in declining muscle strength in residents. As we have demonstrated, this declining muscle strength leads to further physical inactivity and sleep disturbance. We have shown that high intensity PRT is safe, feasible, and markedly increased muscle strength and physical activity in residents with CI. The literature supports our hypothesis that increased daytime physical activity will directly improve nighttime sleep and indirectly improve nighttime sleep by decreasing daytime napping. Future outcome studies require more precise measures of sleep. Other investigators have used actigraphy 31,32 or observations by nursing home staff. The only study that measured sleep using polysomnography occurred in an assisted living facility with cognitively intact elders. Polysomnography, the gold standard for sleep measurement, precisely measures nocturnal total sleep time and sleep stages. Investigators have conducted descriptive studies of sleep in CI elders using polysomnography, but no one to our knowledge has measured the efficacy of an intervention using it. Although actigraphy and observation are better tolerated in CI elders than polysomnography, only polysomnography can provide information on the effects of the intervention on important variables that affect sleep quality such as sleep stages. For example, consistent effects of exercise on stages 2, 3 and 4 NREM sleep in young adults would have remained undetected if researchers had only used actigraphy or observation to measure sleep. The literature supports our hypothesis that the proposed ISA and PRT will each increase nocturnal total sleep time and sleep-wake rhythm amplitude. Further, combining ISA and PRT will result in the greatest improvement in nighttime total sleep time and sleep-wake rhythm amplitude because they will each increase the homeostatic sleep drive, and they will each increase circadian pacemaker entrainment. No other team has investigated the effect of high intensity PRT on sleep in elders with CI. Further, no other research team has targeted residents with disturbed sleep. This is extremely important because conducting an intervention for every resident, or even every incontinent resident, is too costly and unlikely for nursing home staffs to implement. We have shown that ISA reduces excessive daytime sleep and may improve nighttime sleep in residents with CI, but our findings were inconclusive. Further testing with more sensitive instrumentation is indicated. We propose to use polysomnography to more precisely reflect total sleep time.