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Anderson AR, Ostermiller L, Lastrapes M, Hales L. Does sunlight exposure predict next-night sleep? A daily diary study among U.S. adults. J Health Psychol 2024:13591053241262643. [PMID: 39077837 DOI: 10.1177/13591053241262643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
Poor sleep is becoming increasingly prevalent and is associated with adverse health outcomes. Sunlight exposure may improve sleep by regulating circadian rhythms, increasing vitamin D, and influencing melatonin production. However, research on the sunlight-sleep association is limited, especially outside of cross-sectional designs. This study examined associations between daily self-reported sunlight exposure and next-night sleep quality in 103 adults for up to 70 days. The timing of sunlight exposure predicted next-night sleep quality. Specifically, morning sunlight exposure, relative to no sunlight, predicted better sleep quality based on responses to the brief Pittsburg Sleep Quality Index. Duration of sunlight exposure was generally not associated with sleep quality. Morning sunlight may regulate circadian rhythms, subsequently improving sleep. Findings have potential implications for sleep interventions and daylight savings time policies. Future research should test whether morning sunlight exposure can enhance the effectiveness of sleep interventions.
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Volkers KM, Douma JG, Hoeksma JB, Scherder EJA. Effect of an 18-Month Walking Intervention on the Rest-Activity Rhythm of Older Adults With Mild-Moderate Dementia. J Aging Phys Act 2024; 32:350-359. [PMID: 38335947 DOI: 10.1123/japa.2022-0450] [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: 12/30/2022] [Revised: 05/12/2023] [Accepted: 11/14/2023] [Indexed: 02/12/2024]
Abstract
The objective of this 18-month walking intervention was to evaluate the effect on rest-activity rhythm (RAR) for older adults with mild-to-moderate dementia (65.8% female; aged M = 82.4 [SD = 6.5]). The intervention group (n = 44) was intended to walk 30 min, five times per week for 18 months. The control group (n = 35) received sedentary activities or usual care. RAR was measured at baseline to after 18 months and five times in between actigraphy outcome variables (interdaily stability, intradaily variability, relative amplitude, activity 10 most active hours, and activity 5 least active hours). Hierarchical mixed model analyses revealed no significant intervention effects (with or without baseline confounders as covariate) on RAR. However, participants in the intervention group were able to significantly increase their daily life activity (activity 10 most active hours) from the onset of the preceding measurement, b = 0.10, t(239.32) = 2.36, p = .019. More research is warranted to study the effect of regular walks on older persons with dementia whose RAR is worst at baseline.
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Affiliation(s)
| | | | - Jan Binne Hoeksma
- Clinical Neuropsychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Erik Johan Anton Scherder
- Clinical Neuropsychology, Vrije Universiteit, Amsterdam, The Netherlands
- Center for Human Movement Sciences, University of Groningen, Groningen, The Netherlands
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Martin JL, Cadogan M, Brody AA, Mitchell MN, Hernandez DE, Mangold M, Alessi CA, Song Y, Chodosh J. Improving Sleep Using Mentored Behavioral and Environmental Restructuring (SLUMBER). J Am Med Dir Assoc 2024; 25:925-931.e3. [PMID: 38493807 PMCID: PMC11065626 DOI: 10.1016/j.jamda.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To evaluate the impact of a mentoring program to encourage staff-delivered sleep-promoting strategies on sleep, function, depression, and anxiety among skilled nursing facility (SNF) residents. DESIGN Modified stepped-wedge unit-level intervention. SETTING AND PARTICIPANTS Seventy-two residents (mean age 75 ± 15 years; 61.5% female, 41% non-Hispanic white, 35% Black, 20% Hispanic, 3% Asian) of 2 New York City urban SNFs. METHODS Expert mentors provided SNF staff webinars, in-person workshops, and weekly sleep pearls via text messaging. Resident data were collected at baseline, post-intervention (V1), and 3-month follow-up (V2), including wrist actigraphy, resident behavioral observations, Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9) depression scale, Brief Anxiety and Depression Scale (BADS), Brief Cognitive Assessment Tool (BCAT), and select Minimum Data Set 3.0 (MDS 3.0) measures. Linear mixed models were fit for continuous outcomes and mixed-effects logistic models for binary outcomes. Outcomes were modeled as a function of time. Planned contrasts compared baseline to V1 and V2. RESULTS There was significant improvement in PSQI scores from baseline to V1 (P = .009), and from baseline to V2 (P = .008). Other significant changes between baseline and V1 included decreased depression (PHQ-9) (P = .028), increased daytime observed out of bed (P ≤ .001), and increased daytime observed being awake (P < .001). At V2 (vs baseline) being observed out of bed decreased (P < .001). Daytime sleeping by actigraphy increased from baseline to V1 (P = .004), but not V2. MDS 3.0 activities of daily living and pain showed improvements by the second quarter following implementation of SLUMBER (P's ≤ .034). There were no significant changes in BADS or BCAT between baseline and V1 or V2. CONCLUSIONS AND IMPLICATIONS SNF residents had improvements in sleep quality and depression with intervention, but improvements were not sustained at 3-month follow-up. The COVID-19 pandemic led to premature study termination, so full impacts remain unknown.
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Affiliation(s)
- Jennifer L Martin
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Mary Cadogan
- School of Nursing, University of California, Los Angeles, CA, USA
| | - Abraham A Brody
- Rory Meyers College of Nursing, New York University, New York City, NY, USA; Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA
| | - Michael N Mitchell
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Diana E Hernandez
- Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA
| | - Michael Mangold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai (Beth Israel), New York City, NY, USA
| | - Cathy A Alessi
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; School of Nursing, University of California, Los Angeles, CA, USA
| | - Yeonsu Song
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA; School of Nursing, University of California, Los Angeles, CA, USA
| | - Joshua Chodosh
- Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA; Medicine Service, VA New York Harbor Healthcare System, New York City, NY, USA.
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Chodosh J, Cadogan M, Brody AA, Mitchell MN, Hernandez DE, Mangold M, Alessi CA, Song Y, Martin JL. Implementation Outcomes for the SLUMBER Sleep Improvement Program in Long-Term Care. J Am Med Dir Assoc 2024; 25:932-938.e1. [PMID: 38493806 PMCID: PMC11065623 DOI: 10.1016/j.jamda.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To describe the implementation of a mentored staff-delivered sleep program in nursing facilities. DESIGN Modified stepped-wedge unit-level intervention. SETTING AND PARTICIPANTS This program was implemented in 2 New York City nursing facilities, with partial implementation (due to COVID-19) in a third facility. METHODS Expert mentors provided staff webinars, in-person workshops, and weekly sleep pearls via text messaging. We used the integrated Promoting Action on Research Implementation in Health Services (i-PARiHS) framework as a post hoc approach to describe key elements of the SLUMBER implementation. We measured staff participation in unit-level procedures and noted their commentary during unit workshops. RESULTS We completed SLUMBER within 5 units across 2 facilities and held 15 leadership meetings before and during program implementation. Sessions on each unit included 3 virtual webinar presentations and 4 in-person workshops for each nursing shift, held over a period of 3 to 4 months. Staff attendance averaged >3 sessions per individual staff member. Approximately 65% of staff present on each unit participated in any given session. Text messaging was useful for engagement, educational reinforcement, and encouraging attendance. We elevated staff as experts in the care of their residents as a strategy for staff engagement and behavior change and solicited challenging cases from staff during workshops to provide strategies to address resident behavior and encourage adoption when successful. CONCLUSIONS AND IMPLICATIONS Engaging staff, leadership, residents, and family of nursing facilities in implementing a multicomponent sleep quality improvement program is feasible for improving nursing facilities' sleep environment. The program required gaining trust at multiple levels through presence and empathy, and reinforcement mechanisms (primarily text messages). To improve scalability, SLUMBER could evolve from an interdisciplinary investigator-based approach to internal coaches in a train-the-trainer model to effectively and sustainably implement this program to improve sleep quality for facility residents.
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Affiliation(s)
- Joshua Chodosh
- Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA; Medicine Service, VA New York Harbor Healthcare System, New York City, NY, USA.
| | - Mary Cadogan
- School of Nursing, University of California, Los Angeles, CA, USA
| | - Abraham A Brody
- Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA; Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, New York University, New York City, NY, USA
| | - Michael N Mitchell
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Diana E Hernandez
- Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA
| | - Michael Mangold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai (Beth Israel), New York City, New York, USA
| | - Cathy A Alessi
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yeonsu Song
- School of Nursing, University of California, Los Angeles, CA, USA; Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jennifer L Martin
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Klatt T, Bauer I, Behrendt D, Berg A. [Structured case conference for sleep disturbances in nursing home residents with cognitive impairment]. Pflege 2024. [PMID: 38234247 DOI: 10.1024/1012-5302/a000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Structured case conference for sleep disturbances in nursing home residents with cognitive impairment Abstract: Background: Nursing home residents living with cognitive impairment often suffer from sleep disturbances. Pharmacological interventions are not recommended to be the first-choice therapy. In general, a wide variance of non-pharmacological interventions is available, but no clearly suitable intervention can currently be specified. Aim: The case report presents the procedure of a structured analysis to support the selection of non-pharmacological interventions to promote sleep. Methods: A structured case conference was held using a developed case management template to draw up an individual intervention plan. Results: Based on the description of the situation and the determination of causes, different interventions from six main topics were planned: "offering appropriate activations during daytime", "creating bedtime routines", "checking the sleep environment", "observation of potential physical and psychological causes", "reflection on night care routines", and "use of drug therapies only in exceptional cases". Conclusions: For a successful management of sleep disturbances in nursing home residents living with cognitive impairment, it is essential that the specific sleep-related symptoms and causes are assessed systematically and interprofessionally to be able to work towards an improvement with appropriate measures. In order to obtain adequate solutions, evidence-based expertise should be taken into consideration.
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Affiliation(s)
- Thomas Klatt
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | - Ivonne Bauer
- Altenpflegeheim "Am Georgengarten" des Städtischen Klinikums Dessau, Deutschland
| | - Daniel Behrendt
- Städtisches Klinikum Dessau, Akademisches Lehrkrankenhaus mit Hochschulklinik der Medizinischen Hochschule Brandenburg Theodor Fontane (MHB), Deutschland
| | - Almuth Berg
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Deutschland
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Costello A, Linning-Duffy K, Vandenbrook C, Donohue K, O'Hara BF, Kim A, Lonstein JS, Yan L. Effects of light therapy on sleep/wakefulness, daily rhythms, and the central orexin system in a diurnal rodent model of seasonal affective disorder. J Affect Disord 2023; 332:299-308. [PMID: 37060954 PMCID: PMC10161688 DOI: 10.1016/j.jad.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 03/31/2023] [Accepted: 04/07/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Bright light therapy (BLT) is the first-line treatment for seasonal affective disorder. However, the neural mechanisms underlying BLT are unclear. To begin filling this gap, the present study examined the impact of BLT on sleep/wakefulness, daily rhythms, and the wakefulness-promoting orexin/hypocretin system in a diurnal rodent, Nile grass rats (Arvicanthis niloticus). METHODS Male and female grass rats were housed under a 12:12 h light/dark cycle with dim light (50 lx) during the day. The experimental group received daily 1-h early morning BLT (full-spectrum white light, 10,000 lx), while the control group received narrowband red light for 4 weeks. Sleep/wakefulness and in-cage locomotor activity were monitored, followed by examination of hypothalamic prepro-orexin and orexin receptors OX1R and OX2R expression in corticolimbic brain regions. RESULTS The BLT group had higher wakefulness during light treatment, better nighttime sleep quality, and improved daily rhythm entrainment compared to controls. The impact of BLT on the orexin system was sex- and brain region-specific, with males showing higher OX1R and OX2R in the CA1, while females showed higher prepro-orexin but lower OX1R and OX2R in the BLA, compared to same-sex controls. LIMITATIONS The present study focused on the orexin system in a limited number of brain regions at a single time point. Sex wasn't a statistical factor, as male and female cohorts were run independently. CONCLUSIONS The diurnal grass rats show similar behavioral responses to BLT as humans, thus could be a good model for further elucidating the neural mechanisms underlying the therapeutic effects of BLT.
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Affiliation(s)
- Allison Costello
- Department of Psychology, Michigan State University, United States of America.
| | | | | | - Kevin Donohue
- Department of Electrical and Computer Engineering, Michigan State University, United States of America
| | - Bruce F O'Hara
- Department of Biology, University of Kentucky, United States of America
| | - Antony Kim
- Department of Architecture, UC Berkeley, United States of America
| | - Joseph S Lonstein
- Department of Psychology, Michigan State University, United States of America; Neuroscience Program, Michigan State University, United States of America
| | - Lily Yan
- Department of Psychology, Michigan State University, United States of America; Neuroscience Program, Michigan State University, United States of America
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Soundscape Awareness Intervention Reduced Neuropsychiatric Symptoms in Nursing Home Residents With Dementia: A Cluster-Randomized Trial With MoSART. J Am Med Dir Assoc 2023; 24:192-198.e5. [PMID: 36528077 DOI: 10.1016/j.jamda.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Auditory environments as perceived by an individual, also called soundscapes, are often suboptimal for nursing home residents. Poor soundscapes have been associated with neuropsychiatric symptoms (NPS). We evaluated the effect of the Mobile Soundscape Appraisal and Recording Technology sound awareness intervention (MoSART+) on NPS in nursing home residents with dementia. DESIGN A 15-month, stepped-wedge, cluster-randomized trial. Every 3 months, a nursing home switched from care as usual to the use of the intervention. INTERVENTION The 3-month MoSART+ intervention involved ambassador training, staff performing sound measurements with the MoSART application, meetings, and implementation of microinterventions. The goal was to raise awareness about soundscapes and their influence on residents. SETTING AND PARTICIPANTS We included 110 residents with dementia in 5 Dutch nursing homes. Exclusion criteria were palliative sedation and deafness. METHODS The primary outcome was NPS severity measured with the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) by the resident's primary nurse. Secondary outcomes were quality of life (QUALIDEM), psychotropic drug use (ATC), staff workload (workload questionnaire), and staff job satisfaction (Maastricht Questionnaire of Job Satisfaction). RESULTS The mean age of the residents (n = 97) at enrollment was 86.5 ± 6.7 years, and 76 were female (76.8%). The mean NPI-NH score was 17.5 ± 17.3. One nursing home did not implement the intervention because of staff shortages. Intention-to-treat analysis showed a clinically relevant reduction in NPS between the study groups (-8.0, 95% CI -11.7, -2.6). There was no clear effect on quality of life [odds ratio (OR) 2.8, 95% CI -0.7, 6.3], psychotropic drug use (1.2, 95% CI 0.9, 1.7), staff workload (-0.3, 95% CI -0.3, 0.8), or staff job satisfaction (-0.2, 95% CI -1.2, 0.7). CONCLUSIONS AND IMPLICATIONS MoSART+ empowered staff to adapt the local soundscape, and the intervention effectively reduced staff-reported levels of NPS in nursing home residents with dementia. Nursing homes should consider implementing interventions to improve the soundscape.
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Wilfling D, Calo S, Dichter MN, Meyer G, Möhler R, Köpke S. Non-pharmacological interventions for sleep disturbances in people with dementia. Cochrane Database Syst Rev 2023; 1:CD011881. [PMID: 36594432 PMCID: PMC9808594 DOI: 10.1002/14651858.cd011881.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sleep disturbances occur frequently in people with dementia with a reported prevalence of up to 40%. Common problems are increased number and duration of awakenings and increased percentage of light sleep. Sleep disturbances are associated with a number of problems for people with dementia, their relatives, and carers. In people with dementia, they may lead to worsening of cognitive symptoms, challenging behaviours such as restlessness or wandering, and further harms, such as accidental falls. Sleep disturbances are also associated with significant carer distress and have been reported as a factor contributing to institutionalisation of people with dementia. As pharmacological approaches have shown unsatisfactory results, there is a need to synthesise the research evidence on non-pharmacological strategies to improve sleep in people with dementia. As interventions are often complex, consisting of more than one active component, and implemented in complex contexts, it may not be easy to identify effective intervention components. OBJECTIVES To evaluate the benefits and harms of non-pharmacological interventions on sleep disturbances in people with dementia compared to usual care, no treatment, any other non-pharmacological intervention, or any drug treatment intended to improve sleep, and to describe the components and processes of any complex intervention included. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was 13 January 2022. SELECTION CRITERIA We included individually or cluster-randomised controlled trials in people with dementia comparing non-pharmacological interventions to improve sleep compared to usual care or to other interventions of any type. Eligible studies had to have a sleep-related primary outcome. We included people with a diagnosis of dementia and sleep problems at baseline irrespective of age, type of dementia, severity of cognitive impairment, or setting. Studies reporting results on a mixed sample (e.g. in a nursing home) were only considered for inclusion if at least 80% of participants had dementia. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. objective sleep-related outcomes (e.g. total nocturnal sleep time, consolidated sleep time at night, sleep efficiency, total wake time at night (or time spent awake after sleep onset), number of nocturnal awakenings, sleep onset latency, daytime/night-time sleep ratio, night-time/total sleep ratio over 24 hours) and 2. ADVERSE EVENTS Our secondary outcomes were 3. subjective sleep-related outcomes, 4. behavioural and psychological symptoms of dementia, 5. quality of life, 6. functional status, 7. institutionalisation, 8. compliance with the intervention, and 9. attrition rates. We used GRADE to assess the certainty of evidence and chose key outcomes to be included in summary of findings tables. MAIN RESULTS We included 19 randomised controlled trials with 1335 participants allocated to treatment or control groups. Fourteen studies were conducted in nursing homes, three included community residents, one included 'inpatients', one included people from a mental health centre, and one included people from district community centres for older people. Fourteen studies were conducted in the US. We also identified nine ongoing studies. All studies applied one or more non-pharmacological intervention aiming to improve physiological sleep in people with dementia and sleep problems. The most frequently examined single intervention was some form of light therapy (six studies), five studies included physical or social activities, three carer interventions, one daytime sleep restriction, one slow-stroke back massage, and one transcranial electrostimulation. Seven studies examined multimodal complex interventions. Risk of bias of included studies was frequently unclear due to incomplete reporting. Therefore, we rated no study at low risk of bias. We are uncertain whether light therapy has any effect on sleep-related outcomes (very low-certainty evidence). Physical activities may slightly increase the total nocturnal sleep time and sleep efficiency, and may reduce the total time awake at night and slightly reduce the number of awakenings at night (low-certainty evidence). Social activities may slightly increase total nocturnal sleep time and sleep efficiency (low-certainty evidence). Carer interventions may modestly increase total nocturnal sleep time, may slightly increase sleep efficiency, and may modestly decrease the total awake time during the night (low-certainty evidence from one study). Multimodal interventions may modestly increase total nocturnal sleep time and may modestly reduce the total wake time at night, but may result in little to no difference in number of awakenings (low-certainty evidence). We are uncertain about the effects of multimodal interventions on sleep efficiency (very low-certainty evidence). We found low-certainty evidence that daytime sleep restrictions, slow-stroke back massage, and transcranial electrostimulation may result in little to no difference in sleep-related outcomes. Only two studies reported information about adverse events, detecting only few such events in the intervention groups. AUTHORS' CONCLUSIONS Despite the inclusion of 19 randomised controlled trials, there is a lack of conclusive evidence concerning non-pharmacological interventions for sleep problems in people with dementia. Although neither single nor multimodal interventions consistently improved sleep with sufficient certainty, we found some positive effects on physical and social activities as well as carer interventions. Future studies should use rigorous methods to develop and evaluate the effectiveness of multimodal interventions using current guidelines on the development and evaluation of complex interventions. At present, no single or multimodal intervention can be clearly identified as suitable for widespread implementation.
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Affiliation(s)
- Denise Wilfling
- Nursing Research Group, Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Stella Calo
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Martin N Dichter
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Fong KNK, Ge X, Ting KH, Wei M, Cheung H. The Effects of Light Therapy on Sleep, Agitation and Depression in People With Dementia: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Alzheimers Dis Other Demen 2023; 38:15333175231160682. [PMID: 36924042 PMCID: PMC10578524 DOI: 10.1177/15333175231160682] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To evaluate the effects of light therapy on the alleviation of sleep disturbances, agitation and depression in people with dementia. METHODS A search was performed in PubMed, Medline, SCOPUS, Web of Science, EMBASE, CINAHL, Cochrane Library, for studies published between 2000 and 2021. RESULTS A total of 4315 articles were screened. Sixteen articles were eligible for this review and 11 randomized controlled studies were included in the meta-analysis. Light therapy had a significant effect on reducing the number of awakenings in sleep (n = 4; 95% CI = -.56, -.05; I2 = 0%; SMD = -.31) but was not significant in reducing the wake after sleep onset (n = 3; 95% CI = -.14, .59; I2 = 0%; SMD = .23), agitation (n = 4; 95% CI = -1.02, .45; I2 = 87%; SMD = -.28) and depression (n = 6; 95% CI = -.80, .40, I2 = 85%; SMD = -.20). CONCLUSION Light therapy appeared to be more effective in terms of alleviating sleep disturbances, rather than reducing agitation and depression, but its long-term effects remain unclear.
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Affiliation(s)
- Kenneth NK Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Xiangyang Ge
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - KH Ting
- University Research Facility in Behavioral and Systems Neuroscience, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Minchen Wei
- Department of Building Environment and Energy Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Hilda Cheung
- Department of Building Environment and Energy Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
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Canazei M, Papousek I, Weiss EM. Light Intervention Effects on Circadian Activity Rhythm Parameters and Nighttime Sleep in Dementia Assessed by Wrist Actigraphy: A Systematic Review and Meta-Analysis. THE GERONTOLOGIST 2022; 62:e614-e628. [PMID: 34788794 DOI: 10.1093/geront/gnab168] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Persons with dementia often show circadian rhythm disturbances and sleep problems. Timed light exposure seems to be a promising nonpharmacological treatment option. In this review, meta-analyses were run on light effects on circadian activity rhythm parameters in persons with dementia measured with wrist actimetry. Furthermore, we update a Cochrane review, published in 2014, on actigraphically measured light effects in nighttime sleep parameters in persons with dementia. RESEARCH DESIGN AND METHODS Four electronic databases were searched for randomized controlled trials. Effects in meta-analyses were summarized by using mean differences and 95% confidence intervals. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to assess the risk of bias and registered the review protocol (PROSPERO: CRD42020149001). RESULTS Thirteen trials met inclusion criteria, and either utilized light therapy devices, ambient room lighting systems, or dawn-dusk interventions. Eleven of these studies were subjected to meta-analyses. They did not reveal significant light effects on circadian activity parameters: amplitude (p = .62; n = 313), acrophase (p = .34; n = 313), intradaily variability (p = .51; n = 354), and interdaily stability (p = .38; n = 354). Furthermore, no light effects were found on sleep parameters: total sleep duration (p = .53; n = 594), sleep efficiency (p = .63; n = 333), wake after sleep onset (p = .95; n = 212), and sleep onset latency (p = .26; n = 156). Subgroup analyses, pooling data from 3 studies including persons with Alzheimer's dementia, also did not show light effects on circadian activity and sleep parameters. The overall risk of bias of included studies was high. DISCUSSION AND IMPLICATIONS There is insufficient evidence for actigraphically measured circadian light effects in persons with dementia. More high-quality research is needed to recommend the application of adjunctive light.
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Affiliation(s)
- Markus Canazei
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Ilona Papousek
- Institute of Psychology, University of Graz, Graz, Austria
| | - Elisabeth M Weiss
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
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11
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Abstract
The timing, duration, and consolidation of sleep result from the interaction of the circadian timing system with a sleep-wake homeostatic process. When aligned and functioning optimally, this allows for wakefulness throughout the day and a long consolidated sleep episode at night. Changes to either the sleep regulatory process or how they interact can result in an inability to fall asleep at the desired time, difficulty remaining asleep, waking too early, and/or difficulty remaining awake throughout the day. This mismatch between the desired timing of sleep and the ability to fall asleep and remain asleep is a hallmark of a class of sleep disorders called the circadian rhythm sleep-wake disorders. In this updated article, we discuss typical changes in the circadian regulation of sleep with aging; how age influences the prevalence, diagnosis, and treatment of circadian rhythm sleep disorders; and how neurologic diseases in older patient impact circadian rhythms and sleep.
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Affiliation(s)
- Jee Hyun Kim
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Gonghangdae-ro 260, Gangseo-gu, Seoul, Republic of Korea
| | - Alexandria R Elkhadem
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue BLI438, Boston, MA 02115, USA
| | - Jeanne F Duffy
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
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12
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Circadian Rhythm Sleep-Wake Disorders. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Moderie C, Carrier J, Dang-Vu TT. [Sleep disorders in patients with a neurocognitive disorder]. Encephale 2021; 48:325-334. [PMID: 34916075 DOI: 10.1016/j.encep.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Sleep disorders are prevalent in patients with a neurocognitive disorder, and diagnosis and treatment in these patients remain challenging in clinical practice. METHODS This narrative review offers a systematic approach to diagnose and treat sleep disorders in neurocognitive disorders. RESULTS Alzheimer's disease is often associated with circadian rhythm disorders, chronic insomnia, and sleep apnea-hypopnea syndrome. Alpha-synucleinopathies (e.g., Parkinson's disease and Lewy body dementia) are often associated with a rapid eye movement sleep behavior disorder, restless legs syndrome, chronic insomnia, and sleep apnea-hypopnea syndrome. A focused history allows to diagnose most sleep disorders. Clinicians should ensure to gather the following information in all patients with a neurocognitive disorder: (1) the presence of difficulties falling asleep or staying asleep, (2) the impact of sleep disturbances on daily functioning (fatigue, sleepiness and other daytime consequences), and (3) abnormal movements in sleep. Sleep diaries and questionnaires can assist clinicians in screening for specific sleep disorders. Polysomnography is recommended if a rapid eye movement sleep behavior disorder or a sleep apnea-hypopnea syndrome are suspected. Sleep complaints should prompt clinicians to ensure that comorbidities interfering with sleep are properly managed. The main treatment for moderate to severe obstructive sleep apnea-hypopnea syndrome remains continuous positive airway pressure, as its efficacy has been demonstrated in patients with neurocognitive disorders. Medications should also be reviewed, and time of administration should be optimized (diuretics and stimulating medications in the morning, sedating medications in the evening). Importantly, cholinesterase inhibitors (especially donepezil) may trigger insomnia. Switching to morning dosing or to an alternative drug may help. Cognitive-behavioral therapy for insomnia is indicated to treat chronic insomnia in neurocognitive disorders. False beliefs regarding sleep should be addressed with the patient and their caregiver. The sleep environment should be optimized (decrease light exposure at night, minimize noise, avoid taking vital signs, etc.). Sleep restriction can be considered as patients with a neurocognitive disorder often spend too much time in bed. The need for naps should be assessed case by case as naps may contribute to insomnia in some patients but allow others to complete their diurnal activities. Trazodone (50mg) may also be used under certain circumstances in chronic insomnia. Recent evidence does not support a role for exogenous melatonin in patients with a neucognitive disorder and insomnia. Patients in long-term care facilities are often deprived of an adequate diurnal exposure to light. Increasing daytime exposure to light may improve sleep and mood. Patients with circadian rhythm disorders can also benefit from light therapy (morning bright light therapy in case of phase delay and evening bright light therapy in case of phase advance). Rapid eye movement sleep behavior disorder can lead to violent behaviors, and the sleeping environment should be secured (e.g., mattress on the floor, remove surrounding objects). Medication exacerbating this disorder should be stopped if possible. High dose melatonin (6 to 18mg) or low dose clonazepam (0.125-0.25mg) at bedtime may be used to reduce symptoms. Melatonin is preferred in first-line as it is generally well tolerated with few side effects. Patients with restless legs syndrome should be investigated for iron deficiency. Medication decreasing dopaminergic activity should be reduced or stopped if possible. Behavioral strategies such as exercise and leg massages may be beneficial. Low-dose dopamine agonists (such as pramipexole 0.125mg two hours before bedtime) can be used to treat the condition, but a prolonged treatment may paradoxically worsen the symptoms. Alpha-2-delta calcium channel ligands can also be used while monitoring for the risk of falls. CONCLUSION Multiple and sustained nonpharmacological approaches are recommended for the treatment of sleep disturbances in patients with neurocognitive disorder. Pharmacological indications remain limited, and further randomized clinical trials integrating a multimodal approach are warranted to evaluate the treatment of sleep disorders in specific neurocognitive disorders.
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Affiliation(s)
- C Moderie
- Département de psychiatrie, université McGill, Montréal, Québec, Canada
| | - J Carrier
- Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada; Département de psychologie, université de Montréal, Montréal, Québec, Canada; Centre d'études avancées en médecine du sommeil, Montréal, Québec, Canada
| | - T T Dang-Vu
- Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada; Département de psychologie, université de Montréal, Montréal, Québec, Canada; Département de santé, kinésiologie et physiologie appliquée, centre d'études en neurobiologie comportementale et centre PERFORM, université Concordia, Montréal, Québec, Canada.
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Figueiro MG, Kales HC. Lighting and Alzheimer's Disease and Related Dementias: Spotlight on Sleep and Depression. LIGHTING RESEARCH & TECHNOLOGY (LONDON, ENGLAND : 2001) 2021; 53:405-422. [PMID: 36532710 PMCID: PMC9753196 DOI: 10.1177/14771535211005835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Alzheimer's disease and related dementias is the collective term for a progressive neurodegenerative disease for which there is presently no cure. This paper focuses on two symptoms of the disease, sleep disturbances and depression, and discusses how light can be used as a non-pharmacological intervention to mitigate their negative effects. Bright days and dark nights are needed for health and well-being, but the present components of the built environment, especially those places where older adults spend most of their days, are too dimly illuminated during the day and too bright at night. To be effective light needs to be correctly specified, implemented, and measured. Yet without the appropriate specification and measurement of the stimulus, researchers will not be able to successfully demonstrate positive results in the field, nor will lighting designers and specifiers have the confidence to implement lighting solutions for promoting better sleep and mood in this population.
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Affiliation(s)
- Mariana G Figueiro
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Helen C Kales
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA
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Prins AJ, Scherder EJA, van Straten A, Zwaagstra Y, Milders MV. Sensory Stimulation for Nursing-Home Residents: Systematic Review and Meta-Analysis of Its Effects on Sleep Quality and Rest-Activity Rhythm in Dementia. Dement Geriatr Cogn Disord 2021; 49:219-234. [PMID: 32920562 DOI: 10.1159/000509433] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Disrupted sleep-wake cycles might be associated with an exacerbation of behavioural disturbances and accelerate disease progression in dementia. The effect of sensory stimulation for improving sleep quality is unclear. METHODS A systematic literature search was performed and all studies examining the effects of a sensory stimulation intervention (i.e. bright light, massage, acupuncture, animal-assisted interventions) on rest-activity rhythm (RAR) and/or nocturnal restlessness in nursing-home residents with dementia were included. RESULTS Sensory stimulation was shown to improve nocturnal behavioural restlessness as well as sleep duration and continuation, but the effect on the number of awakenings, RAR, and daytime sleep was negligible. Notable was the high heterogeneity between studies regarding treatments and patients' characteristics and sleep parameters. CONCLUSION Sleep quality and nocturnal restlessness in nursing-home residents with dementia may benefit from sensory stimulation. An environment with sensory stimulation may prevent or improve sleep disturbances in nursing homes, and thereby contribute to a better quality of life for their patients.
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Affiliation(s)
- Angela Joanna Prins
- Atlant (Elderly Care), Beekbergen, The Netherlands, .,Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands,
| | - Erik J Anton Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands
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Abstract
OBJECTIVES Nursing home residents with dementia are sensitive to detrimental auditory environments. This paper presents the first literature review of empirical research investigating (1) the (perceived) intensity and sources of sounds in nursing homes, and (2) the influence of sounds on health of residents with dementia and staff. DESIGN A systematic review was conducted in PubMed, Web of Science and Scopus. Study quality was assessed with the Mixed Methods Appraisal Tool. We used a narrative approach to present the results. RESULTS We included 35 studies. Nine studies investigated sound intensity and reported high noise intensity with an average of 55-68 dB(A) (during daytime). In four studies about sound sources, human voices and electronic devices were the most dominant sources. Five cross-sectional studies focused on music interventions and reported positives effects on agitated behaviors. Four randomized controlled trials tested noise reduction as part of an intervention. In two studies, high-intensity sounds were associated with decreased nighttime sleep and increased agitation. The third study found an association between music and less agitation compared to other stimuli. The fourth study did not find an effect of noise on agitation. Two studies reported that a noisy environment had negative effects on staff. CONCLUSIONS The need for appropriate auditory environments that are responsive to residents' cognitive abilities and functioning is not yet recognized widely. Future research needs to place greater emphasis on intervention-based and longitudinal study design.
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Characteristics of multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents: a systematic review. Int Psychogeriatr 2021; 33:245-273. [PMID: 32498737 DOI: 10.1017/s1041610220000733] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dementia guidelines propose the use of nonpharmacological interventions for sleep disturbances for older people. Based on available reviews, it seems most likely that multicomponent interventions have the strongest potential to be effective in improving sleep. However, a detailed description of multicomponent interventions is missing. This systematic review aims to identify, describe, and summarize multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents. METHODS This review followed established methodological frameworks for systematic evidence syntheses. A computerized search was conducted in December 2018, using the databases PubMed, CINAHL, Scopus, and Cochrane Library. Two independent reviewers assessed all search results to identify eligible studies and assessed studies' methodological quality following the Cochrane Risk of Bias methodology for randomized controlled trials and the CASP Appraisal Checklist for controlled trials.Evaluation studies of any design investigating multicomponent interventions were included, except case studies. Components of included intervention programs were analyzed applying the TIDieR and CReDECI 2 criteria. RESULTS A total of 2056 studies were identified through the database search; ten publications about nine interventions met the inclusion criteria and were included in the review. The identified interventions can be summarized assigned to the categories "daytime activities," "nighttime activities," "staff training," and "light exposure." The approaches showed similarities and differences in procedures, materials, modes of delivery, intervention provider, and intervention period. None of the studies described any intended interactions between components or considered context characteristics in intervention modeling as well as internal and external facilitators or barriers influencing delivery of intervention. We identified positive or mixed positive effects for sleep-related outcomes for the mentioned categories. CONCLUSIONS The analysis of included interventions demonstrates somehow promising results, although findings are difficult to interpret as interventions were not well described, and the challenges of developing and evaluating complex interventions were not sufficiently acknowledged.
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Affiliation(s)
- Jennifer L Martin
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center
- David Geffen School of Medicine, University of California, Los Angeles
| | - Joshua Chodosh
- VA New York Harbor Healthcare System, New York, NY
- New York University Grossman School of Medicine, New York, NY
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Voysey ZJ, Barker RA, Lazar AS. The Treatment of Sleep Dysfunction in Neurodegenerative Disorders. Neurotherapeutics 2021; 18:202-216. [PMID: 33179197 PMCID: PMC8116411 DOI: 10.1007/s13311-020-00959-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 12/13/2022] Open
Abstract
Sleep dysfunction is highly prevalent across the spectrum of neurodegenerative conditions and is a key determinant of quality of life for both patients and their families. Mounting recent evidence also suggests that such dysfunction exacerbates cognitive and affective clinical features of neurodegeneration, as well as disease progression through acceleration of pathogenic processes. Effective assessment and treatment of sleep dysfunction in neurodegeneration is therefore of paramount importance; yet robust therapeutic guidelines are lacking, owing in part to a historical paucity of effective treatments and trials. Here, we review the common sleep abnormalities evident in neurodegenerative disease states and evaluate the latest evidence for traditional and emerging interventions, both pharmacological and nonpharmacological. Interventions considered include conservative measures, targeted treatments of specific clinical sleep pathologies, established sedating and alerting agents, melatonin, and orexin antagonists, as well as bright light therapy, behavioral measures, and slow-wave sleep augmentation techniques. We conclude by providing a suggested framework for treatment based on contemporary evidence and highlight areas that may emerge as major therapeutic advances in the near future.
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Affiliation(s)
- Zanna J Voysey
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, CB2 0PY, UK
| | - Roger A Barker
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair and WT-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, CB2 0PY, UK
| | - Alpar S Lazar
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.
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Gu X, Zhu J. Roles of Exosomes and Exosomal MicroRNAs in Postoperative Sleep Disturbance. Nat Sci Sleep 2021; 13:1363-1375. [PMID: 34354381 PMCID: PMC8331078 DOI: 10.2147/nss.s310351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/14/2021] [Indexed: 12/30/2022] Open
Abstract
Postoperative sleep disturbance (PSD) often occurs in elderly patients after major surgery and exerts harmful effects on postoperative recovery. PSD may increase the incidence of postoperative fatigue, severe anxiety and depression, pain sensitivity, and cognitive dysfunction, which can cause or aggravate neurodegenerative diseases via amyloid aggregation and tau accumulation. Exosomes are important carriers that mediate the transfer of active substances and genetic information among cells. Recent evidence has shown that exosomes are involved in the pathogenesis of end-organ morbidity caused by sleep disorders via increasing amyloid plaque formation, transmitting tau protein, regulating neuroinflammation, and increasing blood-brain barrier permeability. Additionally, exosomes may be useful for delivering therapeutic genetic materials, such as microRNAs (miRNAs) and proteins, to exert neuroprotective effects and reduce cognitive impairment. However, the molecular mechanisms underlying this process remain to be fully elucidated. This review focuses on exosome-related pathways and the modulatory role of exosomal miRNAs on the pathogenesis of sleep disturbance and neurodegeneration. Moreover, we discuss the advantages of reducing neurotoxic proteins via exosomal intervention and miRNA regulation. Future research in exosome administration may offer new insights into PSD-related pathomechanisms and therapeutics.
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Affiliation(s)
- Xiangyi Gu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Junchao Zhu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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21
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Richardson K, Savva GM, Boyd PJ, Aldus C, Maidment I, Pakpahan E, Loke YK, Arthur A, Steel N, Ballard C, Howard R, Fox C. Non-benzodiazepine hypnotic use for sleep disturbance in people aged over 55 years living with dementia: a series of cohort studies. Health Technol Assess 2021; 25:1-202. [PMID: 33410736 PMCID: PMC7812417 DOI: 10.3310/hta25010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sleep disturbance affects around 60% of people living with dementia and can negatively affect their quality of life and that of their carers. Hypnotic Z-drugs (zolpidem, zopiclone and zaleplon) are commonly used to treat insomnia, but their safety and efficacy have not been evaluated for people living with dementia. OBJECTIVES To estimate the benefits and harms of Z-drugs in people living with dementia with sleep disturbance. DESIGN A series of observational cohort studies using existing data from (1) primary care linked to hospital admission data and (2) clinical cohort studies of people living with dementia. DATA SOURCES Primary care study - Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics mortality data. Clinical cohort studies - the Resource Use and Disease Course in Dementia - Nursing Homes (REDIC) study, National Alzheimer's Coordinating Centre (NACC) clinical data set and the Improving Well-being and Health for People with Dementia (WHELD) in nursing homes randomised controlled trial. SETTING Primary care study - 371 primary care practices in England. Clinical cohort studies - 47 nursing homes in Norway, 34 Alzheimer's disease centres in the USA and 69 care homes in England. PARTICIPANTS Primary care study - NHS England primary care patients diagnosed with dementia and aged > 55 years, with sleep disturbance or prescribed Z-drugs or low-dose tricyclic antidepressants, followed over 2 years. Clinical cohort studies - people living with dementia consenting to participate, followed over 3 years, 12 years and 9 months, for REDIC, NACC and WHELD, respectively. INTERVENTIONS The primary exposure was prescription or use of Z-drugs. Secondary exposures included prescription or use of benzodiazepines, low-dose tricyclic antidepressants and antipsychotics. MAIN OUTCOME MEASURES Falls, fractures, infection, stroke, venous thromboembolism, mortality, cognitive function and quality of life. There were insufficient data to investigate sleep disturbance. RESULTS The primary care study and combined clinical cohort studies included 6809 and 18,659 people living with dementia, with 3089 and 914 taking Z-drugs, respectively. New Z-drug use was associated with a greater risk of fractures (hazard ratio 1.40, 95% confidence interval 1.01 to 1.94), with risk increasing with greater cumulative dose (p = 0.002). The hazard ratio for Z-drug use and hip fracture was 1.59 (95% confidence interval 1.00 to 2.53) and for mortality was 1.34 (95% confidence interval 1.10 to 1.64). No excess risks of falls, infections, stroke or venous thromboembolism were detected. Z-drug use also did not have an impact on cognition, neuropsychiatric symptoms, disability or quality of life. LIMITATIONS Primary care study - possible residual confounding because of difficulties in identifying patients with sleep disturbance and by dementia severity. Clinical cohort studies - the small numbers of people living with dementia taking Z-drugs and outcomes not necessarily being measured before Z-drug initiation restricted analyses. CONCLUSIONS We observed a dose-dependent increase in fracture risk, but no other harms, with Z-drug use in dementia. However, multiple outcomes were examined, increasing the risk of false-positive findings. The mortality association was unlikely to be causal. Further research is needed to confirm the increased fracture risk. Decisions to prescribe Z-drugs may need to consider the risk of fractures, balanced against the impact of improved sleep for people living with dementia and that of their carers. Our findings suggest that when Z-drugs are prescribed, falls prevention strategies may be needed, and that the prescription should be regularly reviewed. FUTURE WORK More research is needed on safe and effective management strategies for sleep disturbance in people living with dementia. STUDY REGISTRATION This study is registered as European Union electronic Register of Post-Authorisation Studies (EU PAS) 18006. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - George M Savva
- School of Health Sciences, University of East Anglia, Norwich, UK
- Quadram Institute, Norwich, UK
| | - Penelope J Boyd
- School of Health Sciences, University of East Anglia, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Clare Aldus
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Eduwin Pakpahan
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nicholas Steel
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
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Bethell J, Aelick K, Babineau J, Bretzlaff M, Edwards C, Gibson JL, Hewitt Colborne D, Iaboni A, Lender D, Schon D, McGilton KS. Social Connection in Long-Term Care Homes: A Scoping Review of Published Research on the Mental Health Impacts and Potential Strategies During COVID-19. J Am Med Dir Assoc 2020; 22:228-237.e25. [PMID: 33347846 PMCID: PMC9186333 DOI: 10.1016/j.jamda.2020.11.025] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 01/23/2023]
Abstract
Objectives Good social connection is associated with better health and wellbeing. However, social connection has distinct considerations for people living in long-term care (LTC) homes. The objective of this scoping review was to summarize research literature linking social connection to mental health outcomes, specifically among LTC residents, as well as research to identify strategies to help build and maintain social connection in this population during COVID-19. Design Scoping review. Settings and Participants Residents of LTC homes, care homes, and nursing homes. Methods We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified an aspect of social connection among LTC residents; we limited searches to English-language articles published from database inception to search date (July 2019). For the current analysis, we included studies that reported (1) the association between social connection and a mental health outcome, (2) the association between a modifiable risk factor and social connection, or (3) intervention studies with social connection as an outcome. From studies in (2) and (3), we identified strategies that could be implemented and adapted by LTC residents, families and staff during COVID-19 and included the articles that informed these strategies. Results We included 133 studies in our review. We found 61 studies that tested the association between social connection and a mental health outcome. We highlighted 12 strategies, informed by 72 observational and intervention studies, that might help LTC residents, families, and staff build and maintain social connection for LTC residents. Conclusions and Implications Published research conducted among LTC residents has linked good social connection to better mental health outcomes. Observational and intervention studies provide some evidence on approaches to address social connection in this population. Although further research is needed, it does not obviate the need to act given the sudden and severe impact of COVID-19 on social connection in LTC residents.
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Affiliation(s)
- Jennifer Bethell
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Katelynn Aelick
- Behavioural Supports Ontario Provincial Coordinating Office, North Bay Regional Health Centre, North Bay, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, Canada; The Institute for Education Research, University Health Network, Toronto, Canada
| | - Monica Bretzlaff
- Behavioural Supports Ontario Provincial Coordinating Office, North Bay Regional Health Centre, North Bay, Canada
| | | | | | - Debbie Hewitt Colborne
- Behavioural Supports Ontario Provincial Coordinating Office, North Bay Regional Health Centre, North Bay, Canada
| | - Andrea Iaboni
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Dee Lender
- Ontario Association of Residents' Councils, Newmarket, Canada
| | - Denise Schon
- Lakeside Long-Term Care Centre Family Council, Toronto, Canada
| | - Katherine S McGilton
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Auerswald T, Meyer J, von Holdt K, Voelcker-Rehage C. Application of Activity Trackers among Nursing Home Residents-A Pilot and Feasibility Study on Physical Activity Behavior, Usage Behavior, Acceptance, Usability and Motivational Impact. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6683. [PMID: 32937840 PMCID: PMC7559724 DOI: 10.3390/ijerph17186683] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/27/2020] [Accepted: 09/05/2020] [Indexed: 11/17/2022]
Abstract
The aim of this study was to assess physical activity and sedentary behavior, as well as the usage behavior, usability, acceptance, and motivational impact of an applied activity tracker among nursing home residents. Physical activity and usage behavior were measured among 22 residents (68 to 102 years) by use of a commercial activity tracker worn during waking hours for 77 days on average. Usability, acceptance, and motivational impact of the tracker were examined using an adapted questionnaire. Participants walked, on average, 1007 ± 806 steps per day and spent, on average, more than 9 h (77.2% of their waking time) sedentary. The average steps/day increased significantly within the first five weeks of wearing the activity tracker. The acceptance rate was high (94.4%). The tracker was used for 65.4% of the individual study period, and usage behavior did not significantly change during the first five wearing weeks. Participants with a usage time of ≥50% walked significantly more steps per day than those with a lower usage. Overall, we were able to reveal that the residents were highly inactive and sedentary. The results support the feasibility of a long-term application of activity trackers to assess or even increase physical activity behavior.
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Affiliation(s)
- Tina Auerswald
- Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Thüringer Weg 11, 09126 Chemnitz, Germany;
| | - Jochen Meyer
- OFFIS—Institute for Information Technology Oldenburg, Escherweg 2, 26121 Oldenburg, Germany; (J.M.); (K.v.H.)
| | - Kai von Holdt
- OFFIS—Institute for Information Technology Oldenburg, Escherweg 2, 26121 Oldenburg, Germany; (J.M.); (K.v.H.)
| | - Claudia Voelcker-Rehage
- Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Thüringer Weg 11, 09126 Chemnitz, Germany;
- Department of Neuromotor Behavior and Exercise, University of Münster, Horstmarer Landweg 62 b, 48149 Münster, Germany
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Kim DE, Yoon JY. Factors that Influence Sleep among Residents in Long-Term Care Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061889. [PMID: 32183274 PMCID: PMC7142890 DOI: 10.3390/ijerph17061889] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 01/26/2023]
Abstract
Long-term care residents often experience sleep disturbances as they are vulnerable to a variety of physical, psychosocial, and environmental factors that contribute to sleep disturbances. However, few studies have examined the combined impact of multiple factors on sleep among long-term care residents. This study aimed to identify the factors that influence sleep efficiency and sleep quality based on a modified senescent sleep model. A total of 125 residents were recruited from seven long-term care facilities in South Korea. Sleep patterns and sleep quality were collected using 3-day sleep logs and the Minimal Insomnia Screening Scale for Korean adults (KMISS), respectively. The mean sleep efficiency was 84.6% and the mean score on sleep quality was 15.25. A multiple linear regression analysis showed that greater dependence in activities of daily living (ADL), higher pain, and light at night were related to lower sleep efficiency. Higher pain and fatigue, less activity time, noise and light at night, and lower nighttime staffing levels were related to poorer sleep quality. This study highlights that psychosocial and environmental factors as well as physical factors could influence sleep for long-term care residents. Our findings could be foundational evidence for multi-faceted sleep intervention program development in long-term care settings.
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Affiliation(s)
- Da Eun Kim
- School of Nursing, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Ju Young Yoon
- Research Institute of Nursing Science and College of Nursing, Seoul National University, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-740-8817; Fax: +82-2-741-5244
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Hjetland GJ, Nordhus IH, Pallesen S, Cummings J, Tractenberg RE, Thun E, Kolberg E, Flo E. An Actigraphy-Based Validation Study of the Sleep Disorder Inventory in the Nursing Home. Front Psychiatry 2020; 11:173. [PMID: 32231600 PMCID: PMC7083107 DOI: 10.3389/fpsyt.2020.00173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/24/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Disrupted sleep is common among nursing home patients with dementia and is associated with increased agitation, depression, and cognitive impairment. Detecting and treating sleep problems in this population are therefore of great importance, albeit challenging. Systematic observation and objective recordings of sleep are time-consuming and resource intensive and self-report is often unreliable. Commonly used proxy-rated scales contain few sleep items, which affects the reliability of the raters' reports. The present study aimed to adapt the proxy-rated Sleep Disorder Inventory (SDI) to a nursing home context and validate it against actigraphy. Methods: Cross-sectional study of 69 nursing home patients, 68% women, mean age 83.5 (SD 7.1). Sleep was assessed with the SDI, completed by nursing home staff, and with actigraphy (Actiwatch II, Philips Respironics). The SDI evaluates the frequency, severity, and distress of seven sleep-related behaviors. Internal consistency of the SDI was evaluated by Cronbach's alpha. Spearman correlations were used to evaluate the convergent validity between actigraphy and the SDI. Test performance was assessed by calculating the sensitivity, specificity, and predictive values, and by ROC curve analyses. The Youden's Index was used to determine the most appropriate cut-off against objectively measured sleep disturbance defined as <6 h nocturnal total sleep time (TST) during 8 h nocturnal bed rest (corresponding to SE <75%). Results: The SDI had high internal consistency and convergent validity. Three SDI summary scores correlated moderately and significantly with actigraphically measured TST and wake-after-sleep-onset. A cut-off score of five or more on the SDI summed product score (sum of the products of the frequency and severity of each item) yielded the best sensitivity, specificity, predictive values, and Youden's Index. Conclusion: We suggest a clinical cut-off for the presence of disturbed sleep in institutionalized dementia patients to be a SDI summed product score of five or more. The results suggest that the SDI can be clinically useful for the identification of disrupted sleep when administered by daytime staff in a nursing home context. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03357328.
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Affiliation(s)
- Gunnhild J. Hjetland
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- City Department of Health and Care, Bergen, Norway
- Norwegian Institute of Public Health, Bergen, Norway
| | - Inger Hilde Nordhus
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Jeffrey Cummings
- Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, United States
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Rochelle E. Tractenberg
- Collaborative for Research on Outcomes and –Metrics, Silver Spring, MD, United States
- Departments of Neurology, Biostatistics, Bioinformatics & Biomathematics, and Rehabilitation Medicine, Georgetown University, Washington, DC, United States
| | - Eirunn Thun
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Eirin Kolberg
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Elisabeth Flo
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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Ferini-Strambi L, Galbiati A, Casoni F, Salsone M. Therapy for Insomnia and Circadian Rhythm Disorder in Alzheimer Disease. Curr Treat Options Neurol 2020; 22:4. [PMID: 32025925 DOI: 10.1007/s11940-020-0612-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF THE REVIEW There is strong evidence for a bidirectional association between sleep disorders and Alzheimer's disease (AD). In particular, insomnia may be a potentially modifiable risk factor for AD. The present review summarizes recent advances in treatment of sleep disorders in AD. RECENT FINDINGS Some studies investigated the efficacy and safety of hypnotic agents as ramelteon and mirtazapine to treat sleep disorders in AD but no significant therapeutic effects have been observed. Benzodiazepines are the most frequently used medication for treatment of insomnia but they may cause significant side effects in old subjects. Suvorexant, an orexin receptor antagonist, showed a positive effect on AD insomnia. Recent report suggests an association between trazodone use and delayed cognitive decline in AD. With respect to circadian rhythm disorders, non-pharmacological treatments, especially bright light therapy, could be useful and safe options for treatment in AD. Some pharmacological and non-pharmacological treatments might have benefits in AD patients with sleep disturbances, but further well-designed controlled trials are needed.
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Affiliation(s)
- Luigi Ferini-Strambi
- Department of Clinical Neurosciences, "Vita-Salute" San Raffaele University, Milan, Italy. .,Department of Clinical Neurosciences, Neurology-Sleep Disorder Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Andrea Galbiati
- Department of Clinical Neurosciences, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Francesca Casoni
- Department of Clinical Neurosciences, Neurology-Sleep Disorder Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Salsone
- National Research Council, Institute of Molecular Bioimaging and Physiology, Catanzaro, Italy
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Canazei M, Turiaux J, Huber SE, Marksteiner J, Papousek I, Weiss EM. Actigraphy for Assessing Light Effects on Sleep and Circadian Activity Rhythm in Alzheimer's Dementia: A Narrative Review. Curr Alzheimer Res 2020; 16:1084-1107. [DOI: 10.2174/1567205016666191010124011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/10/2019] [Accepted: 09/08/2019] [Indexed: 12/18/2022]
Abstract
Background:
Alzheimer's Disease (AD) is often accompanied by severe sleep problems and
circadian rhythm disturbances which may to some extent be attributed to a dysfunction in the biological
clock. The 24-h light/dark cycle is the strongest Zeitgeber for the biological clock. People with AD,
however, often live in environments with inappropriate photic Zeitgebers. Timed bright light exposure
may help to consolidate sleep- and circadian rest/activity rhythm problems in AD, and may be a low-risk
alternative to pharmacological treatment.
Objective & Method:
In the present review, experts from several research disciplines summarized the
results of twenty-seven light intervention studies which used wrist actigraphy to measure sleep and circadian
activity in AD patients.
Results:
Taken together, the findings remain inconclusive with regard to beneficial light effects. However,
the considered studies varied substantially with respect to the utilized light intervention, study design,
and usage of actigraphy. The paper provides a comprehensive critical discussion of these issues.
Conclusion:
Fusing knowledge across complementary research disciplines has the potential to critically
advance our understanding of the biological input of light on health and may contribute to architectural
lighting designs in hospitals, as well as our homes and work environments.
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Affiliation(s)
- Markus Canazei
- Research Department, Bartenbach LichtLabor GmbH Ringgold Standard Institution, Bartenbach GmbH, Rinnerstrasse 14, Aldrans 6071, Austria
| | - Julian Turiaux
- Department of Psychology, University of Graz, Graz, Austria
| | - Stefan E. Huber
- Institute of Ion Physics and Applied Physics, University of Innsbruck, Innsbruck, Tirol, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, General Hospital, Milserstrasse 10 , Hall Tirol 6060, Austria
| | - Ilona Papousek
- Department of Psychology, University of Graz, Graz, Austria
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Loewy J. Music Therapy as a Potential Intervention for Sleep Improvement. Nat Sci Sleep 2020; 12:1-9. [PMID: 32021519 PMCID: PMC6954684 DOI: 10.2147/nss.s194938] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/05/2019] [Indexed: 11/23/2022] Open
Abstract
Sleep deficiency is linked to chronic health problems, such as heart disease, kidney disease, high blood pressure, diabetes, stroke, obesity, and depression. Healthcare practitioners are increasingly paying close attention to sleep and its impact on health and wellness as a measure of critical vitality. Sleep's impact on neurologic function, and cognitive endurance affect capacity throughout the lifespan. This article will address recent findings related to the potential of music to induce sleep in illness and wellness. Music therapy research findings and its efficacy as a potent cost-effective intervention will be highlighted.
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Affiliation(s)
- Joanne Loewy
- The Louis Armstrong Center for Music and Medicine, Mount Sinai Beth Israel, New York, NY 10003, USA
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Actigraphic measures of sleep on the wards after ICU discharge. J Crit Care 2019; 54:163-169. [DOI: 10.1016/j.jcrc.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 11/18/2022]
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Guimarães LDA, Brito TA, Pithon KR, Jesus CSD, Souto CS, Souza SJN, Santos TSD. Depressive symptoms and associated factors in elderly long-term care residents. CIENCIA & SAUDE COLETIVA 2019; 24:3275-3282. [PMID: 31508748 DOI: 10.1590/1413-81232018249.30942017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/31/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the prevalence and factors associated with depressive symptoms in institutionalized elderly. METHODS This is an epidemiological cross-sectional study with 42 elderly in a Long-Term Care Institution for the Elderly (LTCIE). Data was collected from April to December 2014 through a questionnaire with information on demographic and socioeconomic aspects, the Geriatric Depression Scale short version (GDS-15) and the Mini Mental State Examination (MMSE). RESULTS Of the elderly studied, 54.8% had depressive symptoms and were predominantly females (64.7%). There was a significant association between depressive symptoms and variables retired (p = 0.043); urinary incontinence (p = 0.028); self-perceived health (p-value = 0.042) and sleep quality (p-value = 0.000). CONCLUSION The study found a high prevalence of depressive symptoms in institutionalized elderly, associated with the presence of urinary incontinence, (negative) self-perceived health, (poor) quality of sleep and retirement (yes). Following the study and in the face of the needs of this population, it is necessary to seek measures that act directly on the modifiable variables, preventing and treating them.
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Affiliation(s)
- Lara de Andrade Guimarães
- Departamento de Saúde I, Universidade Estadual do Sudoeste da Bahia. Av. José Moreira Sobrinho s/n, Jequiezinho. 45206-190 Jequié BA Brasil.
| | - Thaís Alves Brito
- Departamento de Saúde I, Universidade Estadual do Sudoeste da Bahia. Av. José Moreira Sobrinho s/n, Jequiezinho. 45206-190 Jequié BA Brasil.
| | - Karla Rocha Pithon
- Departamento de Saúde I, Universidade Estadual do Sudoeste da Bahia. Av. José Moreira Sobrinho s/n, Jequiezinho. 45206-190 Jequié BA Brasil.
| | - Cleber Souza de Jesus
- Departamento de Saúde I, Universidade Estadual do Sudoeste da Bahia. Av. José Moreira Sobrinho s/n, Jequiezinho. 45206-190 Jequié BA Brasil.
| | - Caroline Sampaio Souto
- Departamento de Saúde I, Universidade Estadual do Sudoeste da Bahia. Av. José Moreira Sobrinho s/n, Jequiezinho. 45206-190 Jequié BA Brasil.
| | - Samara Jesus Nascimento Souza
- Departamento de Saúde I, Universidade Estadual do Sudoeste da Bahia. Av. José Moreira Sobrinho s/n, Jequiezinho. 45206-190 Jequié BA Brasil.
| | - Thassyane Silva Dos Santos
- Departamento de Saúde I, Universidade Estadual do Sudoeste da Bahia. Av. José Moreira Sobrinho s/n, Jequiezinho. 45206-190 Jequié BA Brasil.
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Abstract
This article focuses on irregular sleep-wake rhythm disorder (ISWRD) and its associations with several other comorbidities. Irregular sleep-wake rhythm disorder is a circadian disorder characterized by a lack of a clear sleep-wake pattern. The disorder has yet to be fully understood from pathophysiologic perspective. Treatments are available, but there is a need for development of novel interventions. The goal of this article is to focus on multiple aspects of ISWRD.
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Affiliation(s)
- Temitayo Oyegbile
- Georgetown University, MedStar St. Mary's Sleep Lab, Georgetown University Medical Center, 3800 Reservoir Road, Washington, DC 20007, USA.
| | - Aleksandar Videnovic
- MGH Neurological Clinical Research Institute, 165 Cambridge Street, Suite 600, Boston, MA 02114, USA
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Shang B, Yin H, Jia Y, Zhao J, Meng X, Chen L, Liu P. Nonpharmacological interventions to improve sleep in nursing home residents: A systematic review. Geriatr Nurs 2019; 40:405-416. [DOI: 10.1016/j.gerinurse.2019.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/11/2019] [Accepted: 01/17/2019] [Indexed: 12/31/2022]
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O'Caoimh R, Mannion H, Sezgin D, O'Donovan MR, Liew A, Molloy DW. Non-pharmacological treatments for sleep disturbance in mild cognitive impairment and dementia: A systematic review and meta-analysis. Maturitas 2019; 127:82-94. [PMID: 31351523 DOI: 10.1016/j.maturitas.2019.06.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 02/07/2023]
Abstract
No disease-modifying treatments for dementia are available. Sleep disturbance is strongly associated with cognitive impairment. Non-pharmacological treatments targeting sleep may offer an alternative therapeutic approach. We searched PubMed, CINAHL, EMBASE and the Cochrane library for non-pharmacological treatments for sleep disturbance in mild cognitive impairment (MCI) and dementia, published in English from October 1965 to 2018, including all designs, excluding studies of drug therapies. In all, 53 papers representing 48 studies were included. Participant age ranged from 67.3 to 89.4 years. Most studies (79%) had small samples (<50 participants, range 1-173) and were conducted in long-term/residential care (62%). The majority (85%) recruited participants with moderate-severe dementia; mean MMSE scores ranged from 0 to 28.3/30. Four studies examined MCI. Light therapy delivered over 1-10 weeks was the most studied stand-alone intervention (n = 27), and the majority (81.5%) of these studies found improvements on objective or subjective sleep measures, though the evidence was inconclusive with significant clinical and methodological heterogeneity. Seven multi-modal intervention studies were identified, all incorporating light exposure, and six of these reported improved sleep. Other interventions included electrotherapy stimulation (n = 4), physical exercises/activities (n = 4), acupressure/acupuncture (n = 3) and mindfulness/cognitive behavioural therapy (n = 3). Those examining MCI utilised different mono-modal approaches. A meta-analysis of data from randomised controlled trials showed a statistically significant (mean difference = 3.44, 95% CI: 0.89-5.99, I2=0%; p = 0.008) improvement in sleep efficiency between interventions and controls, favouring the pooled interventions (bright light, multi-domain and other therapies). No other significant differences in sleep or non-sleep outcomes were found. While evidence is available for non-pharmacological sleep interventions, particularly multi-domain approaches, studies were diverse and had small samples. More research examining multi-modal interventions, community-dwellers and those with MCI is required.
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Affiliation(s)
- Rónán O'Caoimh
- Clinical Sciences Institute, National University of Ireland, Galway, Costello road, Galway City, Ireland; Saolta University Health Care Group, Galway University Hospital, Galway, Ireland; Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas road, Cork City, Ireland; Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, Cork City, Ireland.
| | - Helen Mannion
- Clinical Sciences Institute, National University of Ireland, Galway, Costello road, Galway City, Ireland.
| | - Duygu Sezgin
- Clinical Sciences Institute, National University of Ireland, Galway, Costello road, Galway City, Ireland.
| | - Mark R O'Donovan
- Clinical Sciences Institute, National University of Ireland, Galway, Costello road, Galway City, Ireland.
| | - Aaron Liew
- Clinical Sciences Institute, National University of Ireland, Galway, Costello road, Galway City, Ireland.
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas road, Cork City, Ireland.
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Magill N, Knight R, McCrone P, Ismail K, Landau S. A scoping review of the problems and solutions associated with contamination in trials of complex interventions in mental health. BMC Med Res Methodol 2019; 19:4. [PMID: 30616508 PMCID: PMC6323722 DOI: 10.1186/s12874-018-0646-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 12/17/2018] [Indexed: 11/23/2022] Open
Abstract
Background In a randomised controlled trial, contamination is defined as the receipt of active intervention amongst participants in the control arm. This review assessed the processes leading to contamination, its typical quantity, methods used to mitigate it, and impact of use of cluster randomisation to prevent it on study findings in trials of complex interventions in mental health. Methods This is a scoping review of trial design approaches and methods of study conduct to address contamination. Studies included were randomised controlled trials of complex interventions in mental health that described the process leading to, amount of, or solution used to counter contamination. The Medline, Embase, and PsycInfo databases were searched for trials published between 2000 and 2015. Risk of bias was assessed using the Jadad score and domains recommended by Cochrane plus some relevant to cluster randomised trials. Results Two hundred and thirty-four articles were included in the review. The main processes that led to contamination were health professionals delivering both active and comparator treatments and communication among clinicians and participants from the different trial arms. Twenty-three trials (10%) measured binary treatment receipt in the control arm with median 13% of participants found to be contaminated (IQR 5–33%). The most common design approach for dealing with contamination was the use of cluster randomisation (n = 93). In addition, many researchers used simple trial conduct methods to minimise contamination due to suspected contamination processes, such as organising for each clinician to provide only one treatment and separating trial arms spatially or temporally. There was little evidence for a relationship between cluster randomisation to avoid contamination and size of treatment effect estimate. Conclusion There was some evidence of modest levels of treatment contamination with a large range, although a minority of studies reported the amount of contamination. A limitation was that many trials described the problem in little detail. Overall there is a need for greater measurement and reporting of treatment receipt in the control arm of trials. Researchers should be aware of trial conduct methods that can be used to minimise contamination without resorting to cluster randomisation. Electronic supplementary material The online version of this article (10.1186/s12874-018-0646-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicholas Magill
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom. .,Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
| | - Ruth Knight
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom
| | - Paul McCrone
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Khalida Ismail
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom
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Deardorff WJ, Grossberg GT. Behavioral and psychological symptoms in Alzheimer's dementia and vascular dementia. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:5-32. [PMID: 31727229 DOI: 10.1016/b978-0-444-64012-3.00002-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent and represent a significant burden for patients and their caregivers. Early recognition and management of these symptoms is crucial as they are associated with increased risk of institutionalization, impairments in daily functioning, reduced quality of life, and more rapid progression to severe dementia. This chapter will discuss the pathophysiology, proposed diagnostic criteria, clinical features, and management of BPSD, including apathy, depression, agitation/aggression, psychosis, and sleep disturbances. Apathy and depression are the most common overall, and apathy is associated with high symptom severity likely because of its greater persistence. Symptoms such as agitation, aggression, hallucinations, and delusions may be especially distressing and dangerous to patients and caregivers. Nonpharmacologic management should be considered first-line therapy in most cases due to the modest and inconsistent evidence base for pharmacologic agents and greater risk of harm. However, the judicious use of pharmacologic agents may be warranted when symptoms are dangerous and/or severely distressing.
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Affiliation(s)
- William James Deardorff
- Department of Psychiatry and Behavioral Neuroscience, St. Louis University School of Medicine, St Louis, MO, United States
| | - George T Grossberg
- Department of Psychiatry and Behavioral Neuroscience, St. Louis University School of Medicine, St Louis, MO, United States.
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Tran HPT, Leonard SD. Geriatric Assessment for Primary Care Providers. PHYSICIAN ASSISTANT CLINICS 2018. [DOI: 10.1016/j.cpha.2018.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Circadian Rhythm and Alzheimer's Disease. Med Sci (Basel) 2018; 6:medsci6030052. [PMID: 29933646 PMCID: PMC6164904 DOI: 10.3390/medsci6030052] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 12/14/2022] Open
Abstract
Alzheimer’s disease (AD) is a neurodegenerative disorder with a growing epidemiological importance characterized by significant disease burden. Sleep-related pathological symptomatology often accompanies AD. The etiology and pathogenesis of disrupted circadian rhythm and AD share common factors, which also opens the perspective of viewing them as a mutually dependent process. This article focuses on the bi-directional relationship between these processes, discussing the pathophysiological links and clinical aspects. Common mechanisms linking both processes include neuroinflammation, neurodegeneration, and circadian rhythm desynchronization. Timely recognition of sleep-specific symptoms as components of AD could lead to an earlier and correct diagnosis with an opportunity of offering treatments at an earlier stage. Likewise, proper sleep hygiene and related treatments ought to be one of the priorities in the management of the patient population affected by AD. This narrative review brings a comprehensive approach to clearly demonstrate the underlying complexities linking AD and circadian rhythm disruption. Most clinical data are based on interventions including melatonin, but larger-scale research is still scarce. Following a pathophysiological reasoning backed by evidence gained from AD models, novel anti-inflammatory treatments and those targeting metabolic alterations in AD might prove useful for normalizing a disrupted circadian rhythm. By restoring it, benefits would be conferred for immunological, metabolic, and behavioral function in an affected individual. On the other hand, a balanced circadian rhythm should provide greater resilience to AD pathogenesis.
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Capezuti E, Sagha Zadeh R, Pain K, Basara A, Jiang NZ, Krieger AC. A systematic review of non-pharmacological interventions to improve nighttime sleep among residents of long-term care settings. BMC Geriatr 2018; 18:143. [PMID: 29914382 PMCID: PMC6006939 DOI: 10.1186/s12877-018-0794-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/27/2018] [Indexed: 12/21/2022] Open
Abstract
Background Disturbances in sleep and circadian rhythms are common among residents of long-term care facilities. In this systematic review, we aim to identify and evaluate the literature documenting the outcomes associated with non-pharmacological interventions to improve nighttime sleep among long-term care residents. Methods The Preferred Reporting Items for Systematic Reviews guided searches of five databases (MEDLINE, Embase, CINAHL, Scopus, and Cochrane Library) for articles reporting results of experimental or quasi-experimental studies conducted in long-term care settings (nursing homes, assisted-living facilities, or group homes) in which nighttime sleep was subjectively or objectively measured as a primary outcome. We categorized each intervention by its intended use and how it was administered. Results Of the 54 included studies evaluating the effects of 25 different non-pharmacological interventions, more than half employed a randomized controlled trial design (n = 30); the others used a pre-post design with (n = 11) or without (n = 13) a comparison group. The majority of randomized controlled trials were at low risk for most types of bias, and most other studies met the standard quality criteria. The interventions were categorized as environmental interventions (n = 14), complementary health practices (n = 12), social/physical stimulation (n = 11), clinical care practices (n = 3), or mind-body practices (n = 3). Although there was no clear pattern of positive findings, three interventions had the most promising results: increased daytime light exposure, nighttime use of melatonin, and acupressure. Conclusions Non-pharmacological interventions have the potential to improve sleep for residents of long-term care facilities. Further research is needed to better standardize such interventions and provide clear implementation guidelines using cost-effective practices. Electronic supplementary material The online version of this article (10.1186/s12877-018-0794-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth Capezuti
- Hunter College School of Nursing and the Graduate Center, City University of New York, 425 E. 25th Street, New York, NY, 10011, USA.
| | - Rana Sagha Zadeh
- Design and Environmental Analysis, Cornell University, 170 Martha Van Rensselaer Hall, Ithaca, NY, 14853-4401, USA
| | - Kevin Pain
- Weill Cornell Medicine, Samuel J. Wood Library & C.V. Starr Biomedical Information Center, 1300 York Avenue Room, C-115, New York, NY, 10065-4896, USA
| | - Aleksa Basara
- Department of Economics, Cornell University, 170 Martha Van Rensselaer Hall, Ithaca, NY, 14853-4401, USA
| | - Nancy Ziyan Jiang
- Health Design Innovations Lab, Department of Design & Environmental Analysis, Cornell University, 170 Martha Van Rensselaer Hall, Ithaca, NY, 14853-4401, USA
| | - Ana C Krieger
- Departments of Medicine, Neurology and Genetic Medicine, Weill Cornell Medical College, Cornell University, 425 E. 61st St., 5th Floor, New York, NY, 10065, USA
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Feasibility of a Cognitive-Behavioral and Environmental Intervention for Sleep-Wake Difficulties in Community-Dwelling Cancer Patients Receiving Palliative Care. Cancer Nurs 2018; 42:396-409. [PMID: 29762213 DOI: 10.1097/ncc.0000000000000603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND High rates of sleep-wake difficulties have been found in patients with cancer receiving palliative care. Pharmacotherapy is the most frequently used treatment option to manage these difficulties despite numerous adverse effects and the absence of empirical evidence of its efficacy and innocuity in palliative care. OBJECTIVE This pilot study aimed to assess the feasibility and acceptability of a cognitive-behavioral and environmental intervention (CBT-E) to improve insomnia and hypersomnolence in patients with a poor functioning level and to collect preliminary data on its effects. METHODS Six patients with cancer receiving palliative care (Eastern Cooperative Oncology Group score 2-3), who had insomnia and/or hypersomnolence, received 1 CBT-E individual session at home. They applied the strategies for 3 weeks. Patients completed the Insomnia Severity Index, the Epworth Sleepiness Scale, a daily sleep diary, and a 24-hour actigraphic recording (7 days) at pretreatment and posttreatment, in addition to a semistructured interview (posttreatment). RESULTS Participants found strategies easy to apply most of the time, and none was rated as impossible to use because of their health condition. However, their adherence and satisfaction toward CBT-E were highly variable. Results on the effects of CBT-E were heterogeneous, but improvements were observed in patients with a persistent insomnia disorder. CONCLUSIONS The CBT-E protocol tested among this highly selected sample was fairly well received and suggested positive outcomes in some patients, particularly those with an insomnia complaint alone. IMPLICATIONS Efforts should be pursued to adapt CBT-E and develop other nonpharmacological interventions, in order to provide an alternative to pharmacotherapy for sleep-wake difficulties in this population.
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Abstract
Because of a growing, aging population and a shortage of geriatricians in the United States, the care of geriatric patients will mostly devolve to primary care providers. This article reviews the different aspects of a multidimensional, multidisciplinary geriatric assessment. Assessment tools and training of office staff to take on larger roles can help primary care providers reduce the burden of work associated with performing a comprehensive geriatric assessment.
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Capezuti E, Sagha Zadeh R, Woody N, Basara A, Krieger AC. An Integrative Review of Nonpharmacological Interventions to Improve Sleep among Adults with Advanced Serious Illness. J Palliat Med 2018; 21:700-717. [PMID: 29337603 PMCID: PMC6909694 DOI: 10.1089/jpm.2017.0152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sleep fragmentation is common among those with advanced serious illness. Nonpharmacological interventions to improve sleep have few, if any, adverse effects and are often underutilized in these settings. OBJECTIVE We aimed to summarize the literature related to nonpharmacological interventions to improve sleep among adults with advanced serious illness. METHODS We systematically searched six electronic databases for literature reporting sleep outcomes associated with nonpharmacological interventions that included participants with advanced serious illness during the period of 1996-2016. RESULTS From a total of 2731 results, 42 studies met the inclusion criteria. A total of 31 individual interventions were identified, each evaluated individually and some in combination with other interventions. Twelve of these studies employed either multiple interventions within an intervention category (n = 8) or a multicomponent intervention consisting of interventions from two or more categories (n = 5). The following intervention categories emerged: sleep hygiene (1), environmental (6), physical activity (4), complementary health practices (11), and mind-body practices (13). Of the 42 studies, 22 demonstrated a statistically significant, positive impact on sleep and represented each of the categories. The quality of the studies varied considerably, with 17 studies classified as strong, 17 as moderate, and 8 as weak. CONCLUSIONS Several interventions have been demonstrated to improve sleep in these patients. However, the small number of studies and wide variation of individual interventions within each category limit the generalizability of findings. Further studies are needed to assess interventions and determine effectiveness and acceptability.
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Affiliation(s)
- Elizabeth Capezuti
- School of Nursing, Hunter College and The Graduate Center, City University of New York, New York, New York
| | - Rana Sagha Zadeh
- Department of Design and Environmental Analysis, Cornell University, Ithaca, New York
| | - Nicole Woody
- Healthcare Strategy and Operations Consultant, New York, New York
| | - Aleksa Basara
- Department of Economics, Health Design Innovations Laboratory, Department of Design and Environmental Analysis, Cornell University, Ithaca, New York
| | - Ana C. Krieger
- Departments of Medicine, Neurology, and Genetic Medicine, Center for Sleep Medicine, Weill Cornell Medical Center, New York, New York
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Abstract
Long-term care (LTC) involves a range of support and services for people with chronic illness and disabilities who can not perform activities of daily living independently. Poor sleep increases the risk of LTC placement, and sleep disturbance is extremely common among LTC residents. The identification and management of sleep disturbance in LTC residents is a vital, but perhaps underappreciated, aspect of offering high-quality care for this already compromised population. This review describes the nature and consequences of sleep disturbances in LTC, clinical assessment and management of sleep disturbances in LTC, and implications for future research and clinical practice.
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Affiliation(s)
- Lichuan Ye
- Bouvé College of Health Sciences School of Nursing, Northeastern University, Boston, MA 02115, USA
| | - Kathy C Richards
- The University of Texas at Austin, School of Nursing, 1710 Red River, Austin, TX 78701, USA.
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Full KM, Schmied EA, Parada H, Cherrington A, Horton LA, Ayala GX. The Relationship Between Sleep Duration and Glycemic Control Among Hispanic Adults With Uncontrolled Type 2 Diabetes. DIABETES EDUCATOR 2017; 43:519-529. [DOI: 10.1177/0145721717724564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose The purpose of this study was to examine the relationship between sleep duration and glycemic control in adult Hispanic patients with uncontrolled type 2 diabetes. Methods This cross-sectional study used baseline data from 317 Hispanic adults with uncontrolled type 2 diabetes who participated in a randomized controlled trial testing a peer support intervention to improve diabetes control. To be eligible, participants had to be 18 years or older and have A1C >7% in the 3 months prior to randomization. Glycemic control was assessed by A1C ascertained through medical chart review; higher A1C levels reflected poorer glycemic control. Sleep duration (hours/night), diabetes control behaviors, and demographics were obtained by interviewer-administered questionnaire. We used multivariable generalized linear models to estimate the association between sleep duration and glycemic control. Results Forty-three percent of participants reported sleeping fewer than 7 hours per night. Sleep duration (hours/night) was inversely associated with A1C levels; however, the relationship was no longer statistically significant after adjusting for insulin status. Conclusions Sleep duration was not significantly associated with glycemic control in this sample of Hispanic adults with uncontrolled type 2 diabetes when adjusting for insulin. Future research should continue to explore this relationship among Hispanic adults with diabetes using an objective measure of sleep duration and a larger sample of Hispanic adults with both controlled and uncontrolled type 2 diabetes to determine if these results hold true.
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Affiliation(s)
- Kelsie M. Full
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Emily A. Schmied
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Humberto Parada
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Andrea Cherrington
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Lucy A. Horton
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Guadalupe X. Ayala
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
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Cognitive-Behavioral Therapy for Insomnia in Cancer Patients: An Update of Efficacy Evidence and Areas for Future Research. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0067-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marques DM, Teixeira HRS, Lopes ARF, Martins-Pedersoli TA, Ziviani LC, Mente ÊD, Castro-E-Silva O, Galvão CM, Mendes KS. Sleep Quality Assessment and Daytime Sleepiness of Liver Transplantation Candidates. Transplant Proc 2017; 48:2356-2360. [PMID: 27742297 DOI: 10.1016/j.transproceed.2016.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the sleep quality and daytime sleepiness of patients eligible for liver transplants. METHODS A cross-sectional prospective study was conducted on liver transplant candidates from a transplant center in the interior of São Paulo State. The Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale questionnaires were applied to obtain demographic and clinical characteristics and to assess sleep quality and daytime sleepiness. RESULTS The mean (±SD) score on the Epworth Sleepiness Scale of the 45 liver transplantation candidates was 7.00 ± 2.83 points, with 28.89% having scores >10 points, indicating excessive daytime sleepiness. The mean score on the Pittsburgh Sleep Quality Index was 6.64 ± 4.95 points, with 60% of the subjects showing impaired sleep quality, with scores >5 points. The average sleep duration was 07:16 h. Regarding sleep quality self-classification, 31.11% reported poor or very poor quality. It is noteworthy that 73.33% of patients had to go to the bathroom, 53.33% woke up in the middle of the night, and 40.00% reported pain related to sleeping difficulties. Comparison of subjects with good and poor sleep quality revealed a significant difference in time to sleep (P = .0002), sleep hours (P = .0003), and sleep quality self-classification (P = .000072). CONCLUSION Liver transplant candidates have a compromised quality of sleep and excessive daytime sleepiness. In clinical practice, we recommend the evaluation and implementation of interventions aimed at improving the sleep and wakefulness cycle, contributing to a better quality of life.
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Affiliation(s)
- D M Marques
- General and Specialized Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - H R S Teixeira
- General and Specialized Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - A R F Lopes
- Special Liver Transplantation Unit, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - T A Martins-Pedersoli
- Special Liver Transplantation Unit, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - L C Ziviani
- Special Liver Transplantation Unit, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ê D Mente
- Special Liver Transplantation Unit, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - O Castro-E-Silva
- Special Liver Transplantation Unit, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - C M Galvão
- General and Specialized Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - K S Mendes
- General and Specialized Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
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Figueiro MG. Light, sleep and circadian rhythms in older adults with Alzheimer's disease and related dementias. Neurodegener Dis Manag 2017; 7:119-145. [PMID: 28534696 PMCID: PMC5836917 DOI: 10.2217/nmt-2016-0060] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/11/2017] [Indexed: 02/04/2023] Open
Abstract
Alzheimer's disease and related dementias (ADRD) can cause sleep and behavioral problems that are problematic for ADRD patients and their family caregivers. Light therapy has shown promise as a nonpharmacological treatment, and preliminary studies demonstrate that timed light exposure can consolidate and improve nighttime sleep efficiency, increase daytime wakefulness and reduce evening agitation without the adverse effects of pharmacological solutions. Compliance with light treatment and the accurate measurement of light exposures during treatment, however, have presented barriers for the adoption of light therapy for ADRD. Recent research showing that the circadian system is maximally sensitive to short-wavelength light opens the way for the potential application of lower, more-targeted light intensities to maximize compliance and individualize light dose/timing in therapeutic settings.
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Affiliation(s)
- Mariana G Figueiro
- Lighting Research Center, Rensselaer Polytechnic Institute, 21 Union Street, Troy, NY 12180, USA
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Abstract
Obstructive sleep apnea (OSA) is present in more than 50% of patients referred to cardiac rehabilitation units. However, it has been under-recognized in patients after stroke and heart failure. Those with concurrent OSA have a worse clinical course. Early treatment of coexisting OSA with continuous positive airway pressure (CPAP) results in improved rehabilitation outcomes and quality of life. Possible mechanisms by which CPAP may improve recovery include decreased blood pressure fluctuations associated with apneas, and improved left ventricular function, cerebral blood flow, and oxygenation. Early screening and treatment of OSA should be integral components of patients entering cardiac rehabilitation units.
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Affiliation(s)
- Behrouz Jafari
- Section of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of California-Irvine, 333 City Boulevard West, Suite 400, Irvine, CA, USA; Sleep Program, VA Long Beach Healthcare System, 5901 East 7th Street, Long Beach, CA 90822, USA.
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