Effect of Activities and Exercise on Sleep in Dementia

描述（由申请人提供）：睡眠障碍是认知障碍患者的一种非常普遍的致残症状，特别是在养老院。他们的夜间睡眠是轻和碎片与频繁醒来。持续的短暂小睡会干扰白天的功能和夜间睡眠。目前对睡眠障碍的干预主要包括药物，但它们已被证明只有最低限度的有效性，并有严重的副作用。需要可行的、具有成本效益的行为干预措施来解决睡眠障碍的诱因，如白天打盹和减少社交和身体活动。因此，本随机对照试验的主要具体目的是确定个体化社会活动、渐进式阻力训练、个体化社会活动和渐进式阻力训练相结合或常规护理控制条件对认知障碍养老院居民夜间总睡眠时间和睡眠-觉醒节律幅度的影响。第二个具体目标是探索白天小睡，肌肉力量和身体活动在介导渐进阻力训练对夜间总睡眠时间的影响中的作用。共有304名有认知障碍的养老院居民将被随机分配接受个性化的社交活动，如游戏或音乐，髋关节和手臂伸肌的高强度渐进式阻力训练，社交活动和渐进式阻力训练相结合，或常规护理控制条件七周。将使用多导睡眠描记、体动描记、直接观察和一次重复最大值测试来测量基线和第7周期间的研究结局。该研究遵循2x2析因设计，并将使用ANOVA进行分析，对夜间总睡眠时间和睡眠-觉醒节律幅度变化的两个主要结局变量进行单独分析。路径分析将被用来探讨白天小睡，肌肉力量，和身体活动在介导渐进阻力训练对夜间总睡眠时间的影响的作用。这项研究将为临床医生提供重要的新的规定性数据，限制白天小睡和促进社交和身体活动的有用性，老年人认知障碍和睡眠障碍。

DESCRIPTION (provided by applicant): Sleep disturbance is a highly prevalent, disabling symptom in persons with cognitive impairment, particularly those in nursing homes. Their nocturnal sleep is light and fragmented with frequent awakenings. Persistent short napping episodes interfere with daytime functioning and nighttime sleep. Current interventions for sleep disturbance consist primarily of pharmacologic agents, but they have proven only minimally effective and have serious side effects. Feasible, cost-effective behavioral interventions that address the precipitating causes of disturbed sleep, such as daytime napping and reduced social and physical activity, are needed. Thus, the primary specific aim for this randomized controlled trial is to determine the effect of individualized social activity, progressive resistance training, combined individualized social activity and progressive resistance training, or a usual care control condition on nocturnal total sleep time and amplitude of the sleep-wake rhythm in nursing home residents with cognitive impairment. The secondary specific aim is to explore the roles of daytime napping, muscle strength, and physical activity in mediating the effect of progressive resistance training on nocturnal total sleep time. A total of 304 nursing home residents with cognitive impairment will be randomly assigned to receive individualized social activity such as games or music, high intensity progressive resistance training of the hip and arm extensors, combined social activity and progressive resistance training, or a usual care control condition for seven weeks. Polysomnography, actigraphy, direct observation, and one-repetition maximum testing will be used to measure the study outcomes at baseline and during week seven. The study follows a 2x2 factorial design, and will be analyzed using ANOVA with separate analyses for the two primary outcome variables of change in nocturnal total sleep time and amplitude of the sleep-wake rhythm. Path analysis will be used to explore the roles of daytime napping, muscle strength, and physical activity in mediating the effect of progressive resistance training on nocturnal total sleep time. This study will provide important new prescriptive data for clinicians on the usefulness of limiting daytime napping and promoting social and physical activity in elders with cognitive impairment and disturbed sleep.