Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.
BMC Geriatr. 2017 Oct 27;17(1):253. doi: 10.1186/s12877-017-0653-7.
Sleep disturbances are widespread among nursing home (NH) patients and associated with numerous negative consequences. Identifying and treating them should therefore be of high clinical priority. No prior studies have investigated the degree to which sleep disturbances as detected by actigraphy and by the sleep-related items in the Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory - Nursing Home version (NPI-NH) provide comparable results. Such knowledge is highly needed, since both questionnaires are used in clinical settings and studies use the NPI-NH sleep item to measure sleep disturbances. For this reason, insight into their relative (dis)advantages is valuable.
Cross-sectional study of 83 NH patients. Sleep was objectively measured with actigraphy for 7 days, and rated by NH staff with the sleep items in the CSDD and the NPI-NH, and results were compared. McNemar's tests were conducted to investigate whether there were significant differences between the pairs of relevant measures. Cohen's Kappa tests were used to investigate the degree of agreement between the pairs of relevant actigraphy, NPI-NH and CSDD measures. Sensitivity and specificity analyses were conducted for each of the pairs, and receiver operating characteristics (ROC) curves were designed as a plot of the true positive rate against the false positive rate for the diagnostic test.
Proxy-raters reported sleep disturbances in 20.5% of patients assessed with NPI-NH and 18.1% (difficulty falling asleep), 43.4% (multiple awakenings) and 3.6% (early morning awakenings) of patients had sleep disturbances assessed with CSDD. Our results showed significant differences (p<0.001) between actigraphy measures and proxy-rated sleep by the NPI-NH and CSDD. Sensitivity and specificity analyses supported these results.
Compared to actigraphy, proxy-raters clearly underreported NH patients' sleep disturbances as assessed by sleep items in NPI-NH and CSDD. The results suggest that the usefulness of proxy-rater measures of sleep may be questionable and further research is needed into their clinical value. The results highlight the need for NH staff to acquire and act on knowledge about sleep and sleep challenges among NH patients.
Registered at www.clinicaltrials.gov (registration number NCT02238652 ) on July 7th 2014 (6 months after study initiation).
睡眠障碍在养老院（NH）患者中普遍存在，并与许多负面后果相关。因此，识别和治疗这些问题应该是临床的首要任务。以前没有研究调查过通过活动记录仪和 Cornell 痴呆抑郁量表（CSDD）中的睡眠相关项目以及神经精神疾病 - 养老院版（NPI-NH）中的睡眠项目检测到的睡眠障碍的程度，这些项目提供的结果是否具有可比性。由于这两个问卷都在临床环境中使用，并且研究使用 NPI-NH 的睡眠项目来测量睡眠障碍，因此非常需要了解这方面的知识。因此，了解它们的相对（不）优势是很有价值的。
对 83 名 NH 患者进行横断面研究。使用活动记录仪对睡眠进行了 7 天的客观测量，并由 NH 工作人员使用 CSDD 和 NPI-NH 的睡眠项目进行评分，然后比较结果。采用 McNemar 检验比较相关测量的两两差异是否有统计学意义。采用 Cohen's Kappa 检验评估相关的活动记录仪、NPI-NH 和 CSDD 测量的一致性程度。对每对测量进行了敏感性和特异性分析，并设计了接收者操作特征（ROC）曲线，作为诊断测试的真阳性率与假阳性率的关系图。
使用 NPI-NH 评估的患者中有 20.5%的患者被代理评估者报告存在睡眠障碍，使用 CSDD 评估的患者中分别有 18.1%（入睡困难）、43.4%（多次醒来）和 3.6%（清晨醒来）的患者存在睡眠障碍。我们的结果显示，活动记录仪测量与代理评估的 NPI-NH 和 CSDD 的睡眠之间存在显著差异（p<0.001）。敏感性和特异性分析支持这些结果。
与活动记录仪相比，代理评估者明显低估了使用 NPI-NH 和 CSDD 中的睡眠项目评估的 NH 患者的睡眠障碍。结果表明，代理评估者测量睡眠的有用性可能存在疑问，需要进一步研究其临床价值。结果强调了 NH 工作人员需要获得和应用有关 NH 患者睡眠和睡眠挑战的知识的必要性。
于 2014 年 7 月 7 日（研究开始后 6 个月）在 www.clinicaltrials.gov 上注册（注册号：NCT02238652）。
