Department of Psychosocial and Community Health, University of Washington, Seattle, WA 98115, USA.
Am J Geriatr Psychiatry. 2012 Jun;20(6):494-504. doi: 10.1097/JGP.0b013e318248ae79.
To investigate the feasibility of implementing a Sleep Education Program (SEP) for improving sleep in adult family home (AFH) residents with dementia, and the relative efficacy of SEP compared with usual care control in a pilot randomized controlled trial.
Thirty-seven AFH staff-caregivers and 47 residents with comorbid dementia and sleep disturbances.
SEP consisted of four training sessions with staff-caregivers to develop and implement individualized resident behavioral sleep plans.
Treatment fidelity to the SEP was assessed following the National Institutes of Health (NIH) Behavior Change Consortium model utilizing trainer observations and staff-caregiver reports. Resident sleep was assessed by wrist actigraphy at baseline, 1-month posttreatment, and 6-month follow-up. Caregiver reports of resident daytime sleepiness, depression, and disruptive behaviors were also collected.
Each key area of treatment fidelity (SEP delivery, receipt, enactment) was identified, measured, and yielded significant outcomes. Staff-caregivers learned how to identify sleep scheduling, daily activity, and environmental factors that could contribute to nocturnal disturbances and developed and implemented strategies for modifying these factors. SEP decreased the frequency and disturbance level of target resident nocturnal behaviors and improved actigraphically measured sleep percent and total sleep time over the 6-month follow-up period compared with the control condition.
Results suggest behavioral interventions to improve sleep are feasible to implement in adult family homes and merit further investigation as a promising intervention for use with AFH residents with dementia.
研究实施睡眠教育计划（SEP）以改善成年家庭护理院（AFH）痴呆症居民睡眠的可行性，并在试点随机对照试验中比较 SEP 与常规护理对照的相对疗效。
37 名 AFH 工作人员照顾者和 47 名患有共病痴呆症和睡眠障碍的居民。
SEP 包括四次培训课程，培训工作人员照顾者制定和实施个体化居民行为睡眠计划。
根据美国国立卫生研究院（NIH）行为改变联盟模型，通过培训师观察和工作人员照顾者报告，评估 SEP 的治疗保真度。在基线、治疗后 1 个月和 6 个月随访时，通过腕部活动记录仪评估居民睡眠。还收集了照顾者对居民日间嗜睡、抑郁和破坏性行为的报告。
确定、测量并产生了显著结果的每个治疗保真度（SEP 交付、接收、实施）的关键领域。工作人员照顾者学会了如何识别可能导致夜间干扰的睡眠安排、日常活动和环境因素，并制定和实施了改变这些因素的策略。与对照组相比，SEP 降低了目标居民夜间行为的频率和干扰水平，并在 6 个月的随访期间改善了活动记录仪测量的睡眠百分比和总睡眠时间。
结果表明，改善睡眠的行为干预措施在成年家庭护理院实施是可行的，并值得进一步研究，作为一种有前途的干预措施，可用于患有痴呆症的 AFH 居民。
