Martin Jennifer L, Marler Matthew R, Harker Judith O, Josephson Karen R, Alessi Cathy A
Multicampus Program in Geriatric Medicine and Gerontology, University of California, Los Angeles, USA.
J Gerontol A Biol Sci Med Sci. 2007 Jan;62(1):67-72. doi: 10.1093/gerona/62.1.67.
Sleep and circadian rhythms are disrupted among many nursing home (NH) residents. We examined the impact of a multicomponent nonpharmacological intervention on 24-hour rest/activity rhythms among long-stay NH residents.
The study was a randomized controlled trial in which, following a 3-day baseline, participants received 5 days of either usual care (control condition) or the active intervention. The intervention combined increased exposure to outdoor bright light, efforts to keep residents out of bed during the day, structured physical activity, institution of a bedtime routine, and efforts to reduce nighttime noise and light in residents' rooms. For 100 residents with baseline and follow-up wrist actigraphy data (mean age = 87 years; 76% women), rest/activity rhythms were modeled to determine the rhythm acrophase (peak time), nadir (trough time), midline estimating statistic of rhythm (MESOR) (midpoint), amplitude (height of peak), slope, and the rest period/active period ratio (alpha).
The intervention led to an increase in the duration of the "active" portion of the rhythm, which was primarily accounted for by a shift in the rest/activity rhythm rise to an earlier time. Findings persisted when analyses were adjusted for age, cognitive functioning, medical comorbidities, and behavioral disturbances.
These findings suggest that the intervention may effectively improve the robustness of rest/activity rhythms in NH residents. Further research is needed to examine the impact of similar interventions on other measures of circadian rhythms (e.g., body temperature, melatonin) among NH residents.
许多养老院居民存在睡眠和昼夜节律紊乱的问题。我们研究了多成分非药物干预对长期居住在养老院居民24小时休息/活动节律的影响。
该研究为随机对照试验，在3天基线期后，参与者接受5天的常规护理（对照条件）或积极干预。干预措施包括增加户外强光照射时间、白天尽量让居民保持起床状态、有组织的体育活动、建立睡前常规以及努力减少居民房间夜间的噪音和光线。对100名有基线和随访腕部活动记录仪数据的居民（平均年龄 = 87岁；76%为女性），对休息/活动节律进行建模，以确定节律顶点相位（峰值时间）、最低点（谷值时间）、节律中线估计统计量（MESOR）（中点）、振幅（峰值高度）、斜率以及休息期/活动期比值（α）。
干预导致节律“活动”部分的时长增加，这主要是由于休息/活动节律上升时间提前所致。在对年龄、认知功能、合并症和行为障碍进行分析调整后，研究结果依然存在。
这些发现表明，该干预可能有效改善养老院居民休息/活动节律的稳健性。需要进一步研究以考察类似干预对养老院居民昼夜节律其他指标（如体温、褪黑素）的影响。
