Sleep/Cognitive Performance/Older Adults/Insomnia

描述(申请人提供)：失眠影响高达35%的65岁及以上的人。尽管患有失眠(OAWI)的老年人经常抱怨认知功能受损，但此类损害的客观证据一直很少。然而，最近一些相关的研究发现，有证据表明OAWI患者的认知表现存在缺陷。不幸的是，由于典型的相关性设计使用的是“一次性”评估，这些研究只提供了睡眠/认知关系的“快照”。这种方法可以改进，因为睡眠和认知表现都可能表现出相当大的日常变异性，特别是在老年人中。使用重复的每日评估，这些睡眠和认知的波动(个体内变异性或IIV)可以被捕获并建模。由于睡眠被认为在皮质恢复中发挥作用，因此假设睡眠的可变性将预测认知表现的可变性。在这项拟议的研究中，OAWI将在标准的失眠行为治疗程序的整个过程中完成日常日记(睡眠和认知)。这项研究特别具有创新性，因为它将是第一次在干预设计的背景下使用日常日记方法和IIV建模的最新进展。这种新颖的设计/方法组合将为OAWI的睡眠/认知关系提供独特的见解，因此，将对睡眠和认知领域做出有价值的贡献。 本项目的两(2)个具体目标及其关联子目标是： 目的1：证实睡眠治疗对睡眠结局的影响，探讨睡眠干预对认知的影响。Subaim 1.1：探讨睡眠治疗对患者治疗前后睡眠和认知功能变化的影响。Subaim 1.2：调查失眠治疗后睡眠和认知个体内变异性的变化。 目的2：探讨睡眠与认知随时间变化的动态关系。Subaim 2.1：调查睡眠和认知水平和变异性之间的同步关联。Subaim 2.2：调查睡眠和认知水平与变异性之间的滞后关系。Subaim 2.3：调查是否存在具有不同睡眠-认知关系模式的同质亚群。 这项研究本身并不是一项治疗效果研究。之前的研究已经表明，行为疗法对老年失眠有效。然而，将对拟议治疗的成功进行评估，并对成功治疗和未治疗的个体在认知功能和睡眠方面的IIV进行比较(见具体目标1)。

DESCRIPTION (provided by applicant): Insomnia affects up to 35 percent of individuals aged 65 and older. Although older adults with insomnia (OAWI) frequently complain of impaired cognitive functioning, objective evidence of such impairment has been sparse. Recently, however, a handful of correlational studies have found evidence of deficits in cognitive performance in OAWI. Unfortunately, because the typical correlational design utilizes 'one shot' assessments, these studies provide only a 'snapshot' of the sleep/cognition relationship. This approach could be improved as both sleep and cognitive performance may exhibit considerable day-to-day variability, particularly in older adults. Using repeated daily assessments, these fluctuations in sleep and cognition (intraindividual variability or IIV) can be captured and modeled. Because sleep is believed to play a role in cortical recovery, it is hypothesized that variability in sleep will predict variability in cognitive performance. In the proposed study, OAWI will complete daily diaries (sleep & cognitive) throughout the course of a standard behavioral treatment program for insomnia. This study is particularly innovative, because it will be the first to employ daily diary methodology and recent advances in IIV modeling in the context of an intervention design. This novel design/methodology combination will provide unique insights into the sleep/cognition relationship in OAWI and as a result, will make valuable contributions to the fields of sleep and cognition. The two (2) specific aims of this project and their associated subaims are: Aim 1: To confirm the effects of sleep treatment on sleep outcomes, and to explore transfer of sleep intervention to cognition. Subaim 1.1: To investigate influence of sleep treatment on pre-post changes in sleep and cognition. Subaim 1.2: To investigate changes in sleep and cognitive intraindividual variability as a consequence of insomnia treatment. Aim 2: To investigate the dynamic relationship between sleep and cognition over time. Subaim 2.1: To investigate concurrent associations between level and variability in sleep and cognition. Subaim 2.2: To investigate lagged relationships between level and variability in sleep and cognition. Subaim 2.3: To investigate whether there exist homogeneous subgroups with varying patterns of sleep-cognition relationships. This study is not a treatment efficacy study per se. Previous research has already shown behavioral treatment to be effective for late-life insomnia. The success of the proposed treatment will be evaluated, however, and comparisons in IIV in cognitive functioning and sleep between successfully treated and untreated individuals will be made (see Specific Aim 1).