Brown Donnamay T, Westbury Juanita L, Schüz Benjamin
Division of Psychology,School of Medicine,University of Tasmania,Hobart,Australia.
Wicking Dementia Research and Education Centre,School of Medicine,University of Tasmania,Hobart,Australia.
Int Psychogeriatr. 2015 Dec;27(12):1945-55. doi: 10.1017/S1041610215001568. Epub 2015 Oct 2.
The prevalence of dementia in Australian nursing homes is high. A large proportion of residents express themselves through agitated behaviors, with substantial interpersonal and day-to-day variance. One factor that may increase agitation is poor sleep. The current study aimed to determine if sleep influences symptoms of agitation in nursing home residents, and whether this effect differed by dementia status. As benzodiazepines are used widely as hypnotic medication, their impact was also considered.
Actigraph devices worn on residents' non-dominant wrists for three days were used to obtain objective measures of sleep. Symptoms of agitation were assessed using staff responses to two standardized questionnaires - the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory - nursing home version (NPI-NH). Presence of dementia and benzodiazepine use were obtained from resident medical charts.
Forty-nine residents (mean age: 85.57 years) from four nursing homes in Tasmania were included in the study. Results indicated that residents were in bed for an average of 11.04 h and slept for 10.14 h per day. Significant relationships between sleep and verbal as well as non-aggressive agitation were found. No relationships between sleep and aggressive agitation were detected. A significant moderation effect of dementia was found, in which residents without dementia expressed verbal agitation when obtaining less sleep, but not residents with dementia. Benzodiazepine use did not result in significantly more sleep.
These results suggest that sleep could play an important role in explaining agitation, but more research is needed to explore the relationship between sleep and benzodiazepines in nursing home residents.
澳大利亚养老院中痴呆症的患病率很高。很大一部分居民通过激越行为来表达自己，人际间和日常表现存在很大差异。睡眠不佳可能是增加激越情绪的一个因素。本研究旨在确定睡眠是否会影响养老院居民的激越症状，以及这种影响是否因痴呆症状态而异。由于苯二氮䓬类药物被广泛用作催眠药物，因此也考虑了它们的影响。
使用佩戴在居民非优势手腕上三天的活动记录仪来获取睡眠的客观测量数据。使用工作人员对两份标准化问卷（科恩-曼斯菲尔德激越量表（CMAI）和神经精神科问卷-养老院版（NPI-NH））的回答来评估激越症状。从居民病历中获取痴呆症的存在情况和苯二氮䓬类药物的使用情况。
来自塔斯马尼亚州四家养老院的49名居民（平均年龄：85.57岁）被纳入研究。结果表明，居民平均每天卧床时间为11.04小时，睡眠时间为10.14小时。发现睡眠与言语激越以及非攻击性激越之间存在显著关系。未检测到睡眠与攻击性激越之间的关系。发现痴呆症有显著的调节作用，即没有痴呆症的居民在睡眠较少时会表现出言语激越，但患有痴呆症的居民则不会。使用苯二氮䓬类药物并没有显著增加睡眠时间。
这些结果表明，睡眠可能在解释激越情绪方面发挥重要作用，但需要更多研究来探索养老院居民睡眠与苯二氮䓬类药物之间的关系。
