Montgomery P, Dennis J
The University of Oxford Section of Child and Adolescent Psychiatry, Park Hospital, Old Road, Headington, Oxford, UK, OX3 7LQ.
Cochrane Database Syst Rev. 2002;2002(2):CD003403. doi: 10.1002/14651858.CD003403.
The prevalence of sleep problems in adulthood increases with age. While not all sleep changes are pathological in later life, severe disturbances may lead to depression, cognitive impairments, deterioration of quality of life, significant stresses for carers and increased healthcare costs. The most common treatment for sleep disorders (particularly insomnia) is pharmacological. The efficacy of non-drug interventions has been suggested to be slower than pharmacological methods, but with no risk of drug-related tolerance or dependency. Bright light treatment involves participants sitting in front of a "light box" which emits very high (typically 10,000 lux) fluorescent light for periods of around two hours daily. The timing of this light treatment will depend on the irregular timing of the participant's sleep pattern.
To assess the efficacy of bright light therapy in improving sleep quality (sleep timing in particular) amongst adults aged 60 and above.
The following databases were searched: MEDLINE (1966 - January 2001); EMBASE (1980 - January 2001), CINAHL ( 1982 - January 2001; PsychINFO 1970 to 2001; The Cochrane Library (Issue 1, 2001); National Research Register (NRR [2001]). Bibliographies of existing reviews in the area, as well as of all trial reports obtained, were searched. Experts in the field were consulted.
Randomised controlled trials of bright light therapy for primary sleep problems where 80% or more of participants were over 60. Participants must have been screened to exclude those with dementia and/or depression.
Abstracts of studies identified in searches of electronic databases were read and assessed to determine whether they might meet the inclusion criteria.
Reviewers found no trials on which to base conclusions for the effectiveness of this treatment.
REVIEWER'S CONCLUSIONS: When the possible side-effects of standard treatment (hypnotics) are considered, there is a reasonable argument to be made for clinical use of non-pharmacological treatments. In view of the promising results of bright light therapy in other populations with problems of sleep timing, further research into their effectiveness with older adults would seem justifiable.
成年期睡眠问题的患病率随年龄增长而增加。虽然并非所有晚年的睡眠变化都是病理性的，但严重的睡眠障碍可能导致抑郁、认知障碍、生活质量下降、给照料者带来巨大压力以及医疗费用增加。睡眠障碍（尤其是失眠）最常见的治疗方法是药物治疗。非药物干预的疗效被认为比药物治疗方法慢，但没有药物相关耐受性或依赖性的风险。强光治疗要求参与者坐在一个“灯箱”前，灯箱每天发射约两小时的高强度（通常为10000勒克斯）荧光。这种光照治疗的时间安排将取决于参与者不规则的睡眠模式。
评估强光疗法对60岁及以上成年人改善睡眠质量（尤其是睡眠节律）的疗效。
检索了以下数据库：MEDLINE（1966年 - 2001年1月）；EMBASE（1980年 - 2001年1月）；CINAHL（1982年 - 2001年1月）；PsychINFO（1970年至2001年）；Cochrane图书馆（2001年第1期）；国家研究注册库（NRR [2001]）。检索了该领域现有综述以及所有获得的试验报告的参考文献。咨询了该领域的专家。
针对原发性睡眠问题进行强光疗法的随机对照试验，其中80%或更多的参与者年龄超过60岁。参与者必须经过筛查以排除患有痴呆症和/或抑郁症的人。
阅读并评估在电子数据库检索中识别出的研究摘要，以确定它们是否可能符合纳入标准。
综述作者未找到可据此得出该治疗有效性结论的试验。
考虑到标准治疗（催眠药）可能的副作用，有合理的理由支持非药物治疗的临床应用。鉴于强光疗法在其他存在睡眠节律问题人群中取得了有前景的结果，对其在老年人中的有效性进行进一步研究似乎是合理的。
