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Böhmer MN, Oppewal A, Bindels PJE, van Someren EJW, Festen DAM. Long-term effects of environmental dynamic lighting on sleep-wake rhythm, mood and behaviour in older adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:620-638. [PMID: 38504557 DOI: 10.1111/jir.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/19/2024] [Accepted: 02/15/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Sleep-wake problems and depressive symptoms are common in people with intellectual disabilities (IDs) and are thought to be related to the unstable sleep-wake rhythm in this population. Previously, we showed that after increasing environmental light exposure, mid-sleep and sleep onset advanced, and mood improved over a period of 14 weeks after installing environmental dynamic light installations in the living room of people with IDs. We invited participants of that short-term study to take part in the current study on sleep-wake rhythm, mood and behaviour in older adults with IDs 1 year after installing environmental dynamic light installations in the common living rooms of six group homes. METHODS A pre-post study was performed from October 2017 to February 2019. We included 45 participants (63.5 ± 8.5 years, 67% female) from six group home facilities who provided data at baseline (9, 4 and 1 weeks prior to installing light installations), short term (3, 7 and 14 weeks after installing light installations) and 1 year (54 weeks after installing light installations). Wrist activity was measured with actigraphy (GENEActiv) to derive the primary outcome of interdaily stability of sleep-wake rhythms as well as sleep estimates. Mood was measured with the Anxiety, Depression and Mood Scale. Behaviour was measured with the Aberrant Behaviour Checklist. RESULTS One year after installing dynamic lighting, we did not find a change in interdaily stability. Total sleep time decreased (β = -25.40 min; confidence interval: -10.99, -39.82), and sleep onset time was delayed (β = 25.63 min; confidence interval: 11.18, 40.08). No effect on mood or behaviour was found. CONCLUSIONS We did not find a change in sleep-wake rhythm, mood or behaviour in older persons with IDs living in care facilities 1 year after installing the light. We did find evidence for a long-term effect on sleep duration and sleep timing. The results have to be interpreted with care as the current study had a limited number of participants. The need for more research on the long-term effects of enhancing environmental light in ID settings is evident.
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Affiliation(s)
- M N Böhmer
- Department of General Practice, Intellectual Disability Medicine Research, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Middin, Care Organization for People with Intellectual Disabilities, Rijswijk, The Netherlands
| | - A Oppewal
- Department of General Practice, Intellectual Disability Medicine Research, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E J W van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
- Department of Integrative Neurophysiology, Centre for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, and GGZ inGeest, Amsterdam, The Netherlands
| | - D A M Festen
- Department of General Practice, Intellectual Disability Medicine Research, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Ipse de Bruggen, Care Organization for People with Intellectual Disabilities, Zoetermeer, The Netherlands
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Browne EG, King JR, Surtees ADR. Sleep in people with and without intellectual disabilities: a systematic review and meta-analysis. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:1-22. [PMID: 37857569 DOI: 10.1111/jir.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/15/2023] [Accepted: 09/01/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Sleep problems are regularly reported in people with intellectual disabilities. Recent years have seen a substantial increase in studies comparing sleep in people with intellectual disabilities to control participants, with an increase in the use of validated, objective measures. Emerging patterns of differences in sleep time and sleep quality warrant pooled investigation. METHODS A systematic search was conducted across three databases (Ovid Embase, PsycInfo and Medline) and returned all papers comparing sleep in people with intellectual disabilities to a control group, published since the last meta-analysis on the topic. A quality framework was employed to rate the risk of bias across studies. Separate meta-analyses of sleep duration and sleep quality were conducted. Subgrouping compared findings for those studies with participants with genetic syndromes or neurodevelopmental conditions and those with heterogeneous intellectual disability. RESULTS Thirteen new papers were identified and combined with those from the previous meta-analysis to provide 34 papers in total. Quality of studies was generally rated highly, though sampling provided risk of bias and adaptive functioning was rarely measured. People with intellectual disability associated with genetic syndromes or neurodevelopmental conditions sleep for shorter time periods (standardised mean difference = .26) and experience worse sleep quality (standardised mean difference = .68) than their peers. People with intellectual disability of heterogeneous origin show no difference in sleep time but have poorer sleep quality. There was some evidence that age moderated these effects. CONCLUSIONS People with intellectual disability have poorer sleep than those without. Subtle patterns suggest that aetiology of intellectual disability moderates the topography of these difficulties, with further work needed to differentiate common and distinct mechanisms across groups.
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Affiliation(s)
- E G Browne
- School of Psychology, University of Birmingham, Birmingham, UK
| | - J R King
- School of Psychology, University of Birmingham, Birmingham, UK
| | - A D R Surtees
- School of Psychology, University of Birmingham, Birmingham, UK
- Division of Mental Health, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Buimer HP, Siebelink NM, Gaasterland A, van Dam K, Smits A, Frederiks K, van der Poel A. Sleep-wake monitoring of people with intellectual disability: Examining the agreement of EMFIT QS and actigraphy. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1276-1287. [PMID: 37489295 DOI: 10.1111/jar.13146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/23/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Gaining insight into sleep-wake patterns of persons with intellectual disabilities is commonly done using wrist actigraphy. For some people, contactless alternatives are needed. This study compares a contactless bed sensor with wrist actigraphy to monitor sleep-wake patterns of people with moderate to profound intellectual disabilities. METHOD Data were collected with EMFIT QS (activity and presence) and MotionWatch 8/Actiwatch 2 (activity, ambient light, and event marker/sleep diary) for 14 nights in 13 adults with moderate-profound intellectual disabilities residing in intramural care. RESULTS In a care-as-usual setting, EMFIT QS and actigraphy assessment show little agreement on sleep-wake variables. CONCLUSION Currently, EMFIT QS should not be considered an alternative to wrist actigraphy for sleep-wake monitoring. Further research is needed into assessing sleep-wake variables using (contactless) technological devices and how the data should be interpreted within the care context to achieve reliable and valid information on sleep-wake patterns of people with intellectual disabilities.
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Affiliation(s)
- Hendrik P Buimer
- Vilans, National Centre of Expertise for Long-term Care, Utrecht, The Netherlands
| | - Nienke M Siebelink
- Academy Het Dorp, Research & Advisory on Technology in Long-term Care, Arnhem, The Netherlands
| | | | - Kirstin van Dam
- Academy Het Dorp, Research & Advisory on Technology in Long-term Care, Arnhem, The Netherlands
| | | | - Kyra Frederiks
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Agnes van der Poel
- Academy Het Dorp, Research & Advisory on Technology in Long-term Care, Arnhem, The Netherlands
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Harper L, McAnelly S, Walshe I, Ooms A, Tuffrey-Wijne IM. Behavioural sleep problems in children and adults with intellectual disabilities: An integrative literature review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:916-928. [PMID: 37177858 DOI: 10.1111/jar.13116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND People with intellectual disabilities are more likely to experience sleep problems, which can affect quality of life, physical health, mental health and well-being. METHODS An integrative literature review was conducted to investigate what is known about behavioural sleep disturbances in people with an intellectual disability. The search used the following databases: Scopus, PsycInfo and Cinahl, to find papers published since 2015. RESULTS Within intellectual disability research, sleep appears as a common issue due to its high prevalence, negative relationships with an individual's physical and mental health, their quality of life, and impact of sleep problems on family or carers. The growing evidence base appears to support the use of behavioural, lifestyle and pharmacological interventions to improve sleep in people with an intellectual disability. CONCLUSION A wide array of literature provides evidence that people with intellectual disabilities are affected by and need support with their sleep.
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Affiliation(s)
- Lynette Harper
- Health and Life Sciences, Northumbria University, London, UK
| | - Su McAnelly
- Health and Life Sciences, Northumbria University, London, UK
| | - Ian Walshe
- Health and Life Sciences, Northumbria University, London, UK
| | - Ann Ooms
- Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
| | - Irene M Tuffrey-Wijne
- Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
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Valle VID, Mafla-España MA, Silva J, Cauli O. Actigraphy Analysis of Sleep Associates with Salivary IL-6 Concentration in Institutionalized Older Individuals. Diseases 2023; 11:93. [PMID: 37489445 PMCID: PMC10366774 DOI: 10.3390/diseases11030093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/25/2023] [Accepted: 07/02/2023] [Indexed: 07/26/2023] Open
Abstract
Sleep disorders are common in older individuals and are most prevalent in those who are institutionalized. Sleep complaints are often comorbid with medical and neuro-psychiatric illness and associated with polypharmacy. Various studies show an association between sleep disorders and altered levels of inflammatory cytokines, especially IL-6. In this study, an objective sleep analysis was performed using actigraphy, and IL-6 measurements in saliva in 61 older people residing in long-term nursing homes (72.1% women). Almost half (49.2%) of the people had no or mild cognitive impairment, and the rest suffered from moderate to severe dementia, mainly due to Alzheimer's disease (25 out of 31 individuals). A significant correlation was found between salivary IL6 and sleep parameters; e.g., less salivary IL-6 had significantly (p < 0.05) worse sleep efficiency and more night awakenings. In turn, actigraphy detected alterations in people with dementia in average sleep time, daily bedtime, and average daily time out of bed. There was no significant correlation between these sleep patterns and the total number of psychotropic drugs. No significant differences were found in salivary IL-6 between individuals with or without dementia. These results should be considered in future research with institutionalized people to detect sleep disturbances and to establish interventions aimed to improve sleep quality.
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Affiliation(s)
- Vanessa Ibáñez-Del Valle
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, c/de Méndez y Pelayo, 19, 46010 Valencia, Spain
- Frailty and Cognitive Impairment Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Chair of Active Ageing, University of Valencia, 46010 Valencia, Spain
| | - Mayra Alejandra Mafla-España
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, c/de Méndez y Pelayo, 19, 46010 Valencia, Spain
- Frailty and Cognitive Impairment Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Josep Silva
- Valencian Research Institute for Artificial Intelligence, Universitat Politècnica de València, 46010 Valencia, Spain
| | - Omar Cauli
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, c/de Méndez y Pelayo, 19, 46010 Valencia, Spain
- Frailty and Cognitive Impairment Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Chair of Active Ageing, University of Valencia, 46010 Valencia, Spain
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Böhmer MN, Oppewal A, Valstar MJ, Bindels PJE, van Someren EJW, Maes‐Festen DAM. Light up: an intervention study of the effect of environmental dynamic lighting on sleep-wake rhythm, mood and behaviour in older adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:756-781. [PMID: 36004439 PMCID: PMC9541498 DOI: 10.1111/jir.12969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 07/11/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Evidence-based interventions to improve the sleep-wake rhythm, mood and behaviour in older adults with intellectual disabilities (ID) are limited. Increasing light exposure has been shown to be effective in improving the sleep-wake rhythm, mood, and behaviour in other populations. The current study investigates the effect of installing environmental dynamic lighting in common living rooms of care facilities on sleep-wake rhythm, mood, and behaviour in older adults with ID. METHODS A non-randomised, non-concurrent, multiple baseline study was performed from October 2017 to May 2018. Fifty-four participants [mean (SD) age of 63.42 (8.6) years, 65% female] in six care facilities were included. All participants had three baseline measurements (Weeks 1, 5 and 9). Dynamic lighting was installed in Week 10, after which three intervention measurements took place (Weeks 12, 17 and 24). Sleep characteristics and the sleep-wake rhythm were assessed using actigraphy (GENEActiv). Mood was measured with the Anxiety, Depression and Mood Scale (ADAMS) and behaviour with the Aberrant Behaviour Checklist (ABC). RESULTS Mixed-effect regression analysis showed a worsening of the primary outcome interdaily stability (P = 0.001). This could be attributed to one care facility, whereas interdaily stability did not change in the other care facilities (P = 0.74). Dynamic lighting led to earlier mid-sleep (P = 0.003) and sleep onset (P < .0001) and improved mood as indicated by lower scores on the ADAMS depression (-0.64 SD, P < 0.001) and social avoidance (-0.47 SD, P = 0.004) subscales. The prevalence of screening above cut-off for depression decreased from 23 to 9.8% (OR = .16, P = 0.003). For behaviour, a decrease was seen in hyperactivity (-0.43 SD, P < 0.001), lethargy (-0.35 SD, P = 0.008) and irritability (-0.33 SD, P < .001) as measured with the ABC. No adverse effects were reported. CONCLUSION Installing dynamic lighting in common living areas for older adults with ID improved the mood and behaviour of the residents up to 14 weeks after placement. Integrated dynamic lighting is a promising, undemanding and potentially effective addition to improve mood and behaviour in care organisations for people with ID, but does not seem to do so by improving sleep or sleep-wake rhythms.
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Affiliation(s)
- M. N. Böhmer
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- MiddinRijswijkThe Netherlands
| | - A. Oppewal
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - M. J. Valstar
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Medical DepartmentASVZ, Care and Service Centre for People with Intellectual DisabilitiesSliedrechtThe Netherlands
| | - P. J. E. Bindels
- Department of General PracticeErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - E. J. W. van Someren
- Department of Sleep and CognitionNetherlands Institute for NeuroscienceAmsterdamThe Netherlands
- Department of Integrative Neurophysiology, Centre for Neurogenomics and Cognitive Research, Neuroscience Campus AmsterdamVrije UniversiteitAmsterdamThe Netherlands
- Amsterdam UMC, Vrije Universiteit, and GGZ inGeest, Dept. of PsychiatryAmsterdam Public Health Research IllnstituteAmsterdamThe Netherlands
| | - D. A. M. Maes‐Festen
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Ipse de BruggenZoetermeerThe Netherlands
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