Improving Dementia Caregiver Sleep and The Effect on Heart Disease Biomarkers

改善痴呆症护理人员的睡眠及其对心脏病生物标志物的影响

• 批准号: 8705334
• 负责人: Meredeth A Rowe
• 金额: $ 33.09万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-15 至 2017-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8705334
• 关键词: Address; Adult; Affect; Alteplase; Anxiety; Area; Beds; Biological Markers; Blood specimen; C-reactive protein; Cardiovascular Diseases; Caregivers; Caring; Cell Adhesion; Cell Adhesion Molecules; Characteristics; Chronic; Chronically Ill; Coagulation Process; Cognitive Therapy; Coronary heart disease; Data; Data Collection; Dementia; Devices; Disease; Effectiveness; Ensure; Environment; Event; Familial Dementias; Health; Healthcare Systems; Heart Diseases; Home environment; Hour; Housing; Incidence; Individual; Inflammation; Injury; Interleukin-6; Intervention; Left; Life; Link; Long-Term Care; Longitudinal Studies; Measures; Mental Depression; Monitor; Nature; Nursing Homes; Outcome; Participant; Pathology; Persons; Population Study; Precipitating Factors; Premature Mortality; Process; Relative (related person); Research; Research Personnel; Risk; Role; Safety; Science; Secondary to; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Sleeplessness; Subgroup; Supervision; System; Testing; Time; actigraphy; awake; caregiving; comparison group; cytokine; depressive symptoms; design; diaries; dimer; effective therapy; high risk; improved; mortality; programs; research study; satisfaction; trend; vigilance

DESCRIPTION (provided by applicant): Informal caregivers provide the majority of care for chronically ill adults, including persons with dementia. While these individuals provide a great benefit to the chronically ill relative, being a caregiver is associated with deleterious health consequences, including premature mortality and higher rates of coronary heart disease (CHD). Another common complaint among dementia caregivers is poor sleep, which has been connected to premature mortality and higher rates of CHD in noncaregiving adults. Currently no sleep therapies are empirically validated as effective for caregivers of persons with dementia (PWD), and since PWD often arise at night, improving caregiver sleep could be potentially hazardous as a sleeping caregiver cannot provide supervision during night awakenings. Our primary purpose is thus to determine whether a combined intervention is effective in improving sleep in caregivers of PWD who arise at night. The intervention consists of a night home monitoring system that provides reliable alerts to caregivers when PWD leave the bed and move through the house. While this system improved home safety for PWD, it did not affect caregiver sleep, so a more traditional sleep therapy will be added-cognitive-behavioral therapy for insomnia (CBTi). In the proposed study, experimental participants will receive the night home monitoring system + CBTi; control participants will receive only the night home monitoring system. Participants will remain in the study for 24 weeks, with 4 data collection points. We hypothesize experimental participants will have less time awake after going to bed, and improved sleep efficiency (percent time asleep while in bed). Sleep data will be collected for multiple nights using actigraphy and sleep diary. Our secondary research questions focus on the relationship between poor sleep and CHD. Both in adults and in dementia caregivers, there appears to be a link between poor sleep and abnormal levels on coronary heart disease biomarkers, and likely an increase in CHD with poor sleep. We aim to further explore this relationship as well as determine whether levels of biomarkers improve with improved sleep from the intervention. We propose to draw blood samples at 3 data collection points and measure a set of biomarkers indicative of CHD. Our primary expected outcome is an effective, easy-to-use treatment that can improve sleep in dementia CGs with sleep problems. We will continue to build the science on the relationship between sleep and CHD, and to understand mechanisms that may underlie deleterious changes in CG health. Obtaining evidence of the relationship between sleep and CHD biomarkers, supported by preliminary data that improving sleep reverses changes in biomarker levels, would begin to fill a critically important gap in research aiming to reduce the trend of PWD caregiver mortality and CHD as well as PWD placement in nursing homes. A longer study would then be proposed to determine how to deliver effective sleep therapies to sustain normalization of CHD biomarkers, as well as to determine whether the actual disease process was affected.

描述（由申请人提供）：非正式护理人员为慢性病成年人提供大部分护理，包括痴呆症患者。虽然这些人为慢性病患者的亲属提供了很大的好处，但作为照顾者却与有害的健康后果有关，包括过早死亡和冠心病（CHD）的发病率较高。痴呆症照顾者的另一个常见抱怨是睡眠不好，这与非成年人的过早死亡和冠心病发病率较高有关。目前，没有睡眠疗法被经验验证为对痴呆症患者（PWD）的护理者有效，并且由于PWD经常在夜间出现，因此改善护理者睡眠可能是潜在危险的，因为睡眠护理者不能在夜间醒来期间提供监督。因此，我们的主要目的是确定联合干预是否能有效改善夜间起床的PWD护理人员的睡眠。干预包括夜间家庭监测系统，当PWD离开床并在房子里走动时，该系统为护理人员提供可靠的警报。虽然该系统改善了PWD的家庭安全性，但它并不影响护理人员的睡眠，因此将增加一种更传统的睡眠疗法-失眠症认知行为疗法（CBTi）。在拟议的研究中，实验参与者将获得夜间家庭监控系统+ CBTi;对照参与者将仅获得夜间家庭监控系统。受试者将继续参与研究24周，有4个数据收集点。我们假设实验参与者在上床睡觉后醒来的时间更少，睡眠效率（在床上睡觉的时间百分比）提高。将使用活动记录仪和睡眠日记收集多个夜晚的睡眠数据。我们的次要研究问题集中在睡眠不良和CHD之间的关系。在成年人和痴呆症照顾者中，睡眠不良与冠心病生物标志物的异常水平之间似乎存在联系，睡眠不良可能会增加CHD。我们的目标是进一步探索这种关系，并确定生物标志物的水平是否随着干预改善睡眠而改善。我们建议在3个数据收集点抽取血液样本，并测量一组指示CHD的生物标志物。我们的主要预期结果是一种有效，易于使用的治疗方法，可以改善有睡眠问题的痴呆CG的睡眠。我们将继续建立睡眠与CHD之间关系的科学，并了解可能导致CG健康有害变化的机制。获得睡眠和CHD生物标志物之间关系的证据，并得到改善睡眠逆转生物标志物水平变化的初步数据的支持，将开始填补旨在降低PWD护理人员死亡率和CHD趋势以及PWD安置在养老院的研究中的一个至关重要的空白。然后将提出一项更长的研究，以确定如何提供有效的睡眠疗法来维持CHD生物标志物的正常化，以及确定实际的疾病过程是否受到影响。