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。他们的夜间睡眠是浅而零碎的，经常醒来。持续的短暂午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效果，并有严重的副作用。需要采取可行的、具有成本效益的行为干预措施，解决造成睡眠紊乱的原因，如白天打盹和社交和身体活动减少。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、个体化社会活动与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-觉醒节律振幅的影响。第二个具体目的是探索白天午睡、肌肉力量和身体活动在进行性阻力训练对夜间总睡眠时间的影响中的作用。共有304名患有认知障碍的养老院居民将被随机分配接受个性化的社会活动，如游戏或音乐，髋部和手臂伸肌的高强度进行性阻力训练，结合社会活动和进行性阻力训练，或通常的护理控制条件，为期七周。多导睡眠图、活动图、直接观察和单次最大重复测试将用于测量基线和第7周的研究结果。本研究采用2x2析因设计，对夜间总睡眠时间变化和睡眠-觉醒节律幅度这两个主要结局变量分别进行方差分析。通径分析将用于探讨白天午睡、肌肉力量和体力活动在进行性阻力训练对夜间总睡眠时间的影响中的中介作用。这项研究将为临床医生提供重要的新的规范性数据，说明限制白天午睡和促进有认知障碍和睡眠障碍的老年人的社交和身体活动的有效性。

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.