Leggett Amanda N, Liu Yin, Klein Laura Cousino, Zarit Steven H
Department of Psychiatry, University of Michigan.
Department of Human Development and Family Studies, Pennsylvania State University.
Health Psychol. 2016 May;35(5):465-73. doi: 10.1037/hea0000276. Epub 2015 Sep 7.
Sleep complaints are common among caregivers and are associated with detriments in mental and physical health. Cortisol, a biomarker of the stress process, may link sleep with subsequent health changes in caregivers. The current study examines whether sleep duration is directly associated with the cortisol awakening response (CAR), or whether it is moderated by Adult Day Services (ADS) use, an intervention found previously to influence daily CAR by reducing stressor exposure.
Associations were examined in caregivers (N = 158) of individuals with dementia (IWD) on days when IWDs attended ADS and days when IWDs did not attend ADS. Data were gathered over 8 consecutive days. Caregivers were primarily female (87.3%) with a mean age of 61.59. A multilevel growth curve model tested the association of an interaction of today's ADS use and last night's sleep duration with today's CAR as the outcome.
The interaction between ADS use and within-person sleep duration was significant such that when an individual sleeps longer than their average but does not use ADS, they have a smaller or blunted CAR. On the other hand when an individual sleeps longer than their average and uses ADS, they have a higher but nonsignificant CAR. Sleeping shorter than usual was associated with a dynamic rise regardless of ADS use.
Findings indicate that ADS use moderates the association between sleep duration and CAR such that longer than average sleep is associated with blunted, dysregulated cortisol patterns only on non-ADS days.
睡眠问题在照料者中很常见，且与身心健康受损有关。皮质醇作为应激过程的生物标志物，可能将睡眠与照料者随后的健康变化联系起来。本研究旨在探讨睡眠时间是否直接与皮质醇觉醒反应（CAR）相关，或者它是否受到成人日间服务（ADS）使用情况的调节，此前发现这种干预措施可通过减少应激源暴露来影响每日的CAR。
在痴呆症患者（IWD）的照料者（N = 158）中，分别考察IWD参加ADS的日子和未参加ADS的日子里的相关情况。数据连续收集8天。照料者主要为女性（87.3%），平均年龄为61.59岁。采用多级生长曲线模型，以今日的CAR为结果，检验今日ADS使用情况与昨晚睡眠时间的交互作用之间的关联。
ADS使用情况与个体内部睡眠时间之间的交互作用显著，即当一个人睡眠时间超过其平均水平但未使用ADS时，他们的CAR较小或减弱。另一方面，当一个人睡眠时间超过其平均水平且使用ADS时，他们的CAR较高但不显著。无论是否使用ADS，睡眠时间短于平常都与动态上升相关。
研究结果表明，ADS的使用调节了睡眠时间与CAR之间的关联，即只有在非ADS日，睡眠时间超过平均水平才与CAR减弱、皮质醇模式失调相关。
