EFFECT OF ACTIVITIES AND EXERCISE ON SLEEP IN DEMENTIA

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。虽然调查人员已经检查了增加社交或体育活动或两者对养老院和辅助生活设施中老年人睡眠的影响，但一项研究缺乏对照组或显著性测试，另一项研究是在辅助生活设施中进行的，而不是在养老院中，只包括认知完整的参与者，他们更容易参与社交活动和锻炼，另一项研究只研究失禁的居民。在唯一一项没有发现锻炼项目后居民睡眠改善的研究中，锻炼的持续时间（每天几分钟和干预时间的长度）和强度可能不够。长期卧床，害怕跌倒，以及依赖日常生活活动导致肌力下降。正如我们已经证明的那样，这种肌肉力量的下降会导致进一步的缺乏运动和睡眠障碍。我们已经证明，高强度PRT是安全、可行的，可以显著增加CI患者的肌肉力量和体力活动。文献支持我们的假设，即增加白天的体力活动将直接改善夜间睡眠，并通过减少白天的午睡间接改善夜间睡眠。未来的结果研究需要更精确的睡眠测量。其他研究人员使用了活动记录仪31,32或疗养院工作人员的观察。唯一一项使用多导睡眠图测量睡眠的研究发生在一个辅助生活设施中，参与者是认知完好的老年人。多导睡眠图是睡眠测量的黄金标准，精确测量夜间总睡眠时间和睡眠阶段。研究人员使用多导睡眠描记术对CI老年人的睡眠进行了描述性研究，但据我们所知，还没有人测量过使用多导睡眠描记术的干预效果。尽管活动描图和观察在CI老年人中比多导睡眠描图更容易被接受，但只有多导睡眠描图才能提供干预对影响睡眠质量的重要变量（如睡眠阶段）的影响的信息。例如，如果研究人员仅仅使用活动描记或观察来测量睡眠，运动对年轻人第2、3和4阶段非快速眼动睡眠的持续影响将无法被发现。文献支持我们的假设，即建议的ISA和PRT各自会增加夜间总睡眠时间和睡眠-觉醒节律振幅。此外，结合ISA和PRT将导致夜间总睡眠时间和睡眠-觉醒节律幅度的最大改善，因为它们都将增加体内平衡睡眠驱动，它们都将增加昼夜节律起搏器的干扰。没有其他团队研究过高强度PRT对老年CI患者睡眠的影响。此外，没有其他研究团队针对睡眠紊乱的居民。这是非常重要的，因为对每个居民，甚至每个失禁的居民进行干预，成本太高，养老院的工作人员不太可能实施。我们已经表明，ISA减少了CI患者白天过多的睡眠，并可能改善夜间睡眠，但我们的研究结果尚无定论。建议使用更灵敏的仪器进行进一步测试。我们建议使用多导睡眠图更精确地反映总的睡眠时间。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. While investigators have examined the effects of increasing social or physical activities or both on sleep in elders in nursing homes and assisted living facilities, one study lacked a control group or tests of significance, another was conducted in an assisted living facility as opposed to a nursing home and included only cognitively-intact participants who are much easier to engage in social activities and exercise, and the other studied only incontinent residents. In the only study that did not find an improvement in the sleep of residents after an exercise program, the exercise may have been of insufficient duration (both minutes per day and length of the intervention period) and intensity. Prolonged bedrest, fear of falling, and dependency in activities of daily living result in declining muscle strength in residents. As we have demonstrated, this declining muscle strength leads to further physical inactivity and sleep disturbance. We have shown that high intensity PRT is safe, feasible, and markedly increased muscle strength and physical activity in residents with CI. The literature supports our hypothesis that increased daytime physical activity will directly improve nighttime sleep and indirectly improve nighttime sleep by decreasing daytime napping. Future outcome studies require more precise measures of sleep. Other investigators have used actigraphy 31,32 or observations by nursing home staff. The only study that measured sleep using polysomnography occurred in an assisted living facility with cognitively intact elders. Polysomnography, the gold standard for sleep measurement, precisely measures nocturnal total sleep time and sleep stages. Investigators have conducted descriptive studies of sleep in CI elders using polysomnography, but no one to our knowledge has measured the efficacy of an intervention using it. Although actigraphy and observation are better tolerated in CI elders than polysomnography, only polysomnography can provide information on the effects of the intervention on important variables that affect sleep quality such as sleep stages. For example, consistent effects of exercise on stages 2, 3 and 4 NREM sleep in young adults would have remained undetected if researchers had only used actigraphy or observation to measure sleep. The literature supports our hypothesis that the proposed ISA and PRT will each increase nocturnal total sleep time and sleep-wake rhythm amplitude. Further, combining ISA and PRT will result in the greatest improvement in nighttime total sleep time and sleep-wake rhythm amplitude because they will each increase the homeostatic sleep drive, and they will each increase circadian pacemaker entrainment. No other team has investigated the effect of high intensity PRT on sleep in elders with CI. Further, no other research team has targeted residents with disturbed sleep. This is extremely important because conducting an intervention for every resident, or even every incontinent resident, is too costly and unlikely for nursing home staffs to implement. We have shown that ISA reduces excessive daytime sleep and may improve nighttime sleep in residents with CI, but our findings were inconclusive. Further testing with more sensitive instrumentation is indicated. We propose to use polysomnography to more precisely reflect total sleep time.