Mindfulness Meditation and Insomnia in Alzheimer Disease Caregivers: Inflammatory and Biological Aging Mechanisms

项目摘要/摘要 这项随机对照试验旨在评估经过验证的、基于课程的、以正念为基础的干预措施--失眠正念意识练习(MAP-I)与积极教育控制的睡眠研讨会(SS)--在一年多的随访中治疗患有失眠的老年阿尔茨海默病(AD)配偶照顾者(N=150)的能力。这项研究还旨在确定失眠的治疗是否逆转了疾病风险指标机制的不利轨迹，即炎症和细胞衰老。超过500万美国人提供非正式的AD护理，这对健康产生了负面影响，与不提供护理的对照相比，死亡风险高出63%。失眠发生在超过60%的AD照顾者中，并对照顾者的健康和疾病风险机制产生独立的负面影响。最后，失眠是一个可改变的风险因素，但之前没有研究针对AD照顾者的失眠。我们发现，MAP-I改善了老年人的睡眠抱怨。此外，我们已经证明，基于正念的失眠治疗减少了炎症的细胞和基因组标记物，并减缓了细胞衰老，以一年的端粒侵蚀为指标。晚年的炎症和细胞老化预测发病率和死亡率，使这些生物机制成为AD照顾者疾病风险的宝贵标记物。本研究的具体目的是：1)确定MAP-I与SS对失眠主客观维度的影响；2)评价MAP-I与SS对细胞和基因组炎症标志物的影响；3)评价MAP-I与SS对细胞衰老标志物的影响。我们将探讨照顾者压力对失眠结局的缓解作用，以及MAP-I与SS对照顾者压力结果、健康功能、慢性医学发病率和相关药物使用的影响。如果成功，这项研究将确定对可改变的风险因素失眠的治疗是否影响睡眠和两种疾病风险机制，即炎症和细胞老化，这对改善AD照顾者和老年人的整体健康跨度具有意义。

Project Summary/Abstract This randomized controlled trial aims to evaluate the ability of validated, curriculum based, mindfulness-based intervention known as mindful awareness practices for insomnia (MAP-I) vs. Sleep Seminar (SS), an active education control, to treat insomnia in older adult Alzheimer Disease (AD) spousal caregivers with insomnia (N=150) over one-year follow-up. This study also aims to identify whether treatment of insomnia reverses the adverse trajectories of mechanisms of disease risk indicators, namely inflammation and cellular aging. Over 5 million Americans provide informal AD caregiving, which negatively impacts health and is associated with a 63% greater risk of mortality as compared to non-caregiving controls. Insomnia occurs in over 60% of AD caregivers and has independent negative influences on caregiver health and mechanisms of disease risk. Finally, insomnia is a modifiable risk factor, yet no prior study has targeted insomnia in AD caregivers. We have found that MAP-I improves sleep complaints in older adults. Further, we have shown that mindfulness based treatment of insomnia reduces cellular and genomic markers of inflammation and slows cellular aging as indexed by telomere erosion over a one year period. Inflammation and cellular aging in late life predict morbidity and mortality, making these biological mechanisms valuable markers of disease risk in AD caregivers. The specific aims of the study are to 1) determine the effects of MAP-I vs. SS on subjective and objective dimensions of insomnia; 2) evaluate the effects of MAP-I vs. SS on cellular and genomic markers of inflammation; 3) evaluate the effects of MAP-I vs. SS on markers of cellular aging. We will explore moderating effects of caregiver stress on insomnia outcomes, and also the effects of MAP-I vs. SS on outcomes of caregiver stress, health functioning, chronic medical morbidity and related medication use at follow-up. If successful, this research will identify whether treatment of a modifiable risk factor, insomnia, influences sleep and two mechanisms of disease risk, namely, inflammation and cellular aging, which has implications for improving overall health-span of AD caregivers as well as older adults.