Shih Yen-Hua, Pai Ming-Chyi, Huang Ying-Che, Wang Jing-Jy
Institute of Allied Health Science, National Cheng Kung University, Tainan City, Taiwan, Republic of China; Tzu Hui Institute of Technology, Pingtung County, Taiwan, Republic of China.
Division of Behavioral Neurology, Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China.
J Am Med Dir Assoc. 2017 May 1;18(5):396-401. doi: 10.1016/j.jamda.2016.10.016. Epub 2017 Jan 2.
Sundown syndrome and sleep disturbances cause people with Alzheimer disease (PAD) and caregivers suffering. Studies have indicated that physical exercise could have a positive impact on sundown syndrome, yet no research has ever explored the relationship between walking and sundown syndrome. The aims of this study were to examine the relationship between sundown syndrome and sleep quality, and determine whether the severity of dementia, sleep quality, and weekly duration of walking influenced sundown syndrome, and to assess differences in sundown syndrome and sleep quality in relation to the accompanying walker and weekly duration of walking among people with Alzheimer disease living in the community.
A cross-sectional observation study was conducted.
A total 184 participants were recruited from dementia outpatient clinics of several hospitals and long-term care resource management centers in southern Taiwan. The Chinese version of the Cohen-Mansfield Agitation Inventory, Community form was used to assess sundown syndrome, and the Chinese version of the Pittsburgh Sleep Quality Index was used to measure sleep quality. Pearson correlation, multiple regression, and 1-way analysis of variance were performed for data analysis.
The results indicated that sundown syndrome was significantly correlated with sleep quality (r = 0.374), whereas severity of dementia, sleep quality, and weekly duration of walking were influencing factors of sundown syndrome and accounted for a total of 24.8% of the variance (adjusted R = 0.222, F = 9.709). In addition, PAD who walked with relatives showed less sundown syndrome (F = 4.435, P = .005) and better sleep quality (F = 3.565, P = .015) compared with those walking with nonrelatives. Also, longer walking time led to less sundown syndrome (F = 4.351, P = .002) and better sleep quality (F = 3.592, P = .008).
Advanced dementia, poor sleep quality, and shorter weekly duration of walking were the influencing factors of sundown syndrome. Walking with relatives and regular longer walking time could improve sleep quality and alleviate sundown syndrome. It is suggested that a well-designed walking intervention considering these factors could be an appropriate strategy to manage sundown syndrome and sleep quality for PAD and their caregivers.
日落综合征和睡眠障碍给阿尔茨海默病患者（PAD）及其照护者带来痛苦。研究表明体育锻炼可能对日落综合征有积极影响，但尚无研究探讨步行与日落综合征之间的关系。本研究的目的是检验日落综合征与睡眠质量之间的关系，确定痴呆严重程度、睡眠质量和每周步行时长是否会影响日落综合征，并评估社区中阿尔茨海默病患者在结伴步行者和每周步行时长方面的日落综合征及睡眠质量差异。
进行一项横断面观察研究。
从台湾南部几家医院的痴呆门诊和长期护理资源管理中心招募了184名参与者。采用中文版社区版科恩-曼斯菲尔德激越量表评估日落综合征，采用中文版匹兹堡睡眠质量指数测量睡眠质量。采用Pearson相关性分析、多元回归分析和单因素方差分析进行数据分析。
结果表明，日落综合征与睡眠质量显著相关（r = 0.374），而痴呆严重程度、睡眠质量和每周步行时长是日落综合征的影响因素，共解释了24.8%的变异（调整后R = 0.222，F = 9.709）。此外，与和非亲属一起步行相比，与亲属一起步行的PAD患者日落综合征较少（F = 4.435，P = 0.005），睡眠质量更好（F = 3.565，P = 0.015）。而且，步行时间越长日落综合征越少（F = 4.351，P = 0.002）且睡眠质量越好（F = 3.592，P = 0.008）。
重度痴呆、睡眠质量差和每周步行时长较短是日落综合征的影响因素。与亲属一起步行和规律的较长步行时间可改善睡眠质量并减轻日落综合征。建议考虑这些因素设计的步行干预措施可能是管理PAD患者及其照护者日落综合征和睡眠质量的合适策略。
