Multicomponent Behavioral Sleep Intervention for Insomnia in Older Adults with Mild Cognitive Impairment

项目总结 据估计，7%至20%的老年人患有轻度认知障碍(MCI)，60%的MCI患者患有 一些睡眠障碍。失眠是老年人最常见的睡眠障碍，其特点是难以入睡 开始或维持睡眠，过早醒来，第二天的后果，如难以集中注意力。这个 拟议的项目旨在解决文献和临床实践中的一个主要差距，即缺乏有效的非药理学 轻度认知障碍老年人失眠的治疗。我们建议进行一项随机试验研究 测试一项针对失眠的短暂(4周)、基于平板电脑的、个性化的、多成分的行为睡眠干预(MBSI-I) 这将针对认知能力较弱的老年人中已知的病因风险因素和失眠永久者。 损害，与睡眠教育对照组相比。干预的关键组成部分包括刺激有意义的 白天活动，晚上促进放松疗法。我们将立即初步确定(一个月) MBSI-I的持续疗效(3个月)与睡眠教育的睡眠相关结果和健康相关的比较 生活质量。此外，我们还将探索MBSI-I影响睡眠和健康相关生活质量的机制 使用标准化问卷和炎症生物标志物。实时监控干预遵守情况，使用 移动设备技术与数据的实时传输，代表了失眠治疗的根本性变化 鉴于这一群体有记忆障碍，这将是最有益的。完成后，这项建议将 为大规模干预试验提供基础知识并解决当前失眠治疗中的局限性 在轻度认知障碍的患者中。这项研究与国家研究院的战略使命密切相关 护理研究，因为它提出了个性化护理的策略，并使用实时健康信息来改善 轻度认知障碍老年人的失眠症状，并建立成功症状的证据 在这一弱势群体中的管理。此外，为此制定的跨学科培训计划和目标 建议书将填补我目前技能中的一个关键空白，并为我提供必要的专业知识，以启动成功和 与改善高危老年人睡眠和健康相关生活质量相关的独立研究计划。通过 扩展我的知识，1)移动设备技术，2)认知健康相关结果的测量，3) 行为干预和转化研究的临床试验，4)生物标记物评估，5)科学写作， 口头陈述、手稿开发和同行评议，我将能够进行更有效的研究评估 老年人睡眠问题的非药物治疗。为了促进我的事业成就 为了实现发展目标，我将遵循包括课程作业、实验室培训、指导在内的强化培训计划 以及研讨会、讲习班和其他有组织的活动；参与研究研究、数据分析和手稿 准备；职业发展活动；以及密切的指导。总体而言，这一领域的研究和培训活动 提案将为我作为一名独立调查员的职业生涯奠定坚实的基础。

PROJECT SUMMARY It is estimated that 7% to 20% of older adults have mild cognitive impairment (MCI) and 60% of people with MCI have some sleep disturbances. Insomnia is the most common sleep disturbance in older adults and is characterized by difficulty initiating or maintaining sleep, awakening too early, and next day consequences such as difficulty concentrating. The proposed project seeks to address a major gap in the literature and clinical practice, lack of effective nonpharmacological treatments for insomnia in older adults with mild cognitive impairment. We propose conducting a randomized pilot study testing a brief (4 week), tablet-based, personalized, multicomponent behavioral sleep intervention for insomnia (MBSI-I) that will target known etiological risk factors and perpetuators of insomnia among older adults with mild cognitive impairment, compared to a sleep education control. Key components of the intervention include stimulating meaningful activity during the day and promoting relaxation therapy at night. We will determine preliminary immediate (one month) and sustained efficacy (3 months) of MBSI-I compared to sleep education on sleep related outcomes and health related quality of life. Additionally, we will explore mechanisms by which MBSI-I affects sleep and health related quality of life using standardized questionnaires and inflammatory biomarkers. Real-time monitoring of intervention adherence, using mobile device technology with real time data transmission, represents a fundamental change in the insomnia treatment paradigm and will be most beneficial given that this group has memory impairments. Upon completion, this proposal will provide foundational knowledge for large scale intervention trials and address limitations in current insomnia treatments in patients with mild cognitive impairment. This research closely aligns with the strategic mission of the National Institute of Nursing Research because it proposes strategies to personalize care and use real time health information to improve symptoms of insomnia in older adults with mild cognitive impairment and to build evidence toward successful symptom management in this vulnerable population. Furthermore, the interdisciplinary training plan and goals developed for this proposal will fill a critical void in my current skillset and provide me the expertise necessary to initiate a successful and independent program of research related to improve sleep and health-related quality of life in at-risk older adults. By expanding my knowledge of 1) mobile device technology, 2) measurement of cognitive health related outcomes, 3) clinical trials of behavioral interventions and translational research, 4) biomarker assessment, and 5) scientific writing, oral presentations, manuscript development and peer review, I will be able to conduct research to evaluate more effective nonpharmacological treatments for sleep problems in older adults. To facilitate the achievement of my career development goals, I will follow an intensive training plan that incorporates coursework, laboratory training, mentoring and seminars, workshops, and other structured activities; participation in research studies, data analysis, and manuscript preparation; professional development activities; and close mentorship. Overall, the research and training activities in this proposal will build a strong foundation for my career as an independent investigator.