SleepHab: Effectiveness of Healthy Sleep Habits for Hospitalized Older Adults to Optimize Rehabilitation

项目总结/摘要 与NINR和NCMRR在康复背景下解决睡眠障碍的优先事项一致， 一项提案旨在评估非药物干预对老年患者失眠的疗效 从髋关节或膝关节成形术中恢复过来。每年住院的1500万老年患者中， 报告说，他们在医院就诊期间睡眠受到干扰。睡眠问题可以持续几个月， 住院治疗，并与出院期间和出院后的功能障碍有关。此外，白天 失眠的后遗症，如注意力不集中和疲劳，可能会破坏和限制 康复的有效性。因此，拟议的研究旨在评估急需的安全治疗方法 失眠（失眠的认知行为疗法）与医疗康复相结合，以管理 失眠症状，促进功能健康。改善睡眠有望促进康复， 提高患者参加和遵守康复建议的能力。为了最大限度地让公众 健康影响，改善获取，减少治疗障碍（耻辱和交通问题），我们建议 评估护士和身体干预的有效性和有效性， 职业治疗师在医院床边和家庭环境中。核心假设是， 住院期间和住院后提供的CBTI将改善老年人的睡眠和功能结果 接受医疗康复，并遵循以下目标：（1）评估CBTI在 随机、安慰剂对照试验，（2）确定CBTI对康复的有效性， 健康成果。研究设计最佳且具有充分把握度的主要结局为 主观和客观测量的睡眠。次要结局，我们无法估计其功效 是功能（运动，认知，独立）的结果。我们还将探讨治疗的关系 对其他健康结果的反应，包括炎症水平，药物使用，疲劳，疼痛强度， 抑郁症状严重程度。我们的团队在设计和实施行为 在医院和社区环境中为老年人进行健康临床试验。如果睡眠有效 干预有可能优化康复中的功能增益并减少不良健康状况 因此，我们必须提高生活质量，减少社会的重大成本。

PROJECT SUMMARY/ABSTRACT Consistent with NINR and NCMRR priorities to address sleep disorders in the context of rehabilitation, this proposal aims to evaluate the efficacy of a nonpharmacological intervention for insomnia among older patients recovering from hip or knee arthroplasty. Almost half of the 15 million older patients hospitalized each year report disrupted sleep during their hospital visit. Sleep complaints can persist for several months following hospitalization and are associated with functional impairment during and following discharge. Further, daytime sequela of insomnia, such as diminished attention/concentration and fatigue, may serve to undermine and limit the effectiveness of rehabilitation. Thus, the proposed study aims to evaluate a much-needed safe treatment for insomnia (cognitive behavioral therapy for insomnia) in conjunction with medical rehabilitation to manage insomnia symptoms and promote functional health. Improving sleep is expected to enhance rehabilitation, by increasing patients' abilities to attend and adhere to rehabilitation recommendations. To maximize the public health impact, improve access, and reduce treatment barriers (stigma and transportation issues), we propose to evaluate the efficacy and effectiveness of the intervention delivered by nurses and physical and occupational therapists hospital bedside and in the home environment. The central hypothesis is that tailored CBTI delivered during and following hospitalization will improve sleep and functional outcomes in older adults receiving medical rehabilitation and is guided by the following aims: (1) to evaluate the efficacy of CBTI in a randomized, placebo-controlled trial, and (2) to determine the effectiveness of CBTI on rehabilitation and health outcomes. Primary outcomes, for which the study is optimally designed and sufficiently powered, are subjectively- and objectively-measured sleep. Secondary outcomes, for which we are unable to estimate power are functional (motor, cognition, independence) outcomes. We will also explore the relationship of treatment response to other health outcomes, including level of inflammation, medication use, fatigue, pain intensity, and depressive symptom severity. Our team has extensive experience in designing and implementing behavioral health clinical trials for older adults within hospital and community-based settings. If effective the sleep intervention has the potential to optimize functional gains in rehabilitation and reduce adverse health outcomes, thereby improving quality of life and reducing significant costs to society.