Hoekert Marjolijn, der Lek Rixt F Riemersma-van, Swaab Dick F, Kaufer Daniel, Van Someren Eus J W
Netherlands Institute for Brain Research, Amsterdam, The Netherlands.
Am J Geriatr Psychiatry. 2006 Feb;14(2):104-11. doi: 10.1097/01.JGP.0000192481.27931.c5.
Sleep-wake rhythm disturbances frequently occur in demented elderly and are of clinical relevance because they herald accelerated functional decline and institutionalization. Assessment of sleep-wake rhythm disorders is therefore of significant importance and can be performed by questionnaires or actigraphy, i.e., the recording of wrist activity. The present study investigates the relation of these two types of measurement by simultaneously assessing actigraphy and the Circadian Sleep Inventory for Normal and Pathological States (CSINAPS).
Seventy-eight elderly subjects, mean age 85+/-6 years, living in group care facilities of 12 homes for the elderly, wore an actigraph for two weeks. Caregivers completed the nurse informant CSINAPS. Spearman rank correlations and Mann-Whitney U tests were calculated over the equivalent sleep-wake rhythm parameters as derived from actigraphy and from the CSINAPS.
Good correlations were found between questionnaire items about habitual timing of sleep and wakefulness and their actigraphic counterparts. Caregivers overestimated the actual sleep time between sleep onset and offset by 96 minutes. Questionnaire reports of sleep disturbances like wandering at night were also reflected in actigraphy parameters. However, the questionnaire and actigraphy variables correlate only modestly and may complement each other. In our study, both actigraphy and the CSINAPS seemed to miss the previously established high prevalence of sleep-disordered breathing (SDB) and leg movements during sleep (LM).
The assessment of sleep and wake disturbances in demented elderly is best served by parallel use of a questionnaire like the CSINAPS and actigraphy. Moreover, if SDB and LM are a focus of interest, additional assessments are needed.
睡眠-觉醒节律紊乱在老年痴呆患者中经常出现，且具有临床相关性，因为它们预示着功能加速衰退和需要入住机构养老。因此，评估睡眠-觉醒节律障碍非常重要，可通过问卷调查或活动记录仪（即记录手腕活动）来进行。本研究通过同时评估活动记录仪和用于正常及病理状态的昼夜睡眠量表（CSINAPS）来探究这两种测量方法之间的关系。
78名老年受试者，平均年龄85±6岁，居住在12所养老院的集体护理设施中，佩戴活动记录仪两周。护理人员完成护士告知的CSINAPS。对活动记录仪和CSINAPS得出的等效睡眠-觉醒节律参数进行Spearman等级相关性分析和Mann-Whitney U检验。
关于习惯性睡眠和觉醒时间的问卷项目与其活动记录仪对应项目之间存在良好的相关性。护理人员将入睡至起床的实际睡眠时间高估了96分钟。夜间游荡等睡眠障碍的问卷报告也反映在活动记录仪参数中。然而，问卷和活动记录仪变量之间的相关性仅为中等程度，可能相互补充。在我们的研究中，活动记录仪和CSINAPS似乎都未发现先前确定的睡眠呼吸障碍（SDB）和睡眠期间腿部运动（LM）的高患病率。
对于老年痴呆患者的睡眠和觉醒障碍评估，最好同时使用CSINAPS这样的问卷和活动记录仪。此外，如果SDB和LM是关注重点，则需要进行额外评估。
