1 School of Nursing, Hunter College and The Graduate Center, City University of New York , New York, New York.
2 Department of Design and Environmental Analysis, Cornell University , Ithaca, New York.
J Palliat Med. 2018 May;21(5):700-717. doi: 10.1089/jpm.2017.0152. Epub 2018 Jan 16.
Sleep fragmentation is common among those with advanced serious illness. Nonpharmacological interventions to improve sleep have few, if any, adverse effects and are often underutilized in these settings.
We aimed to summarize the literature related to nonpharmacological interventions to improve sleep among adults with advanced serious illness.
We systematically searched six electronic databases for literature reporting sleep outcomes associated with nonpharmacological interventions that included participants with advanced serious illness during the period of 1996-2016.
From a total of 2731 results, 42 studies met the inclusion criteria. A total of 31 individual interventions were identified, each evaluated individually and some in combination with other interventions. Twelve of these studies employed either multiple interventions within an intervention category (n = 8) or a multicomponent intervention consisting of interventions from two or more categories (n = 5). The following intervention categories emerged: sleep hygiene (1), environmental (6), physical activity (4), complementary health practices (11), and mind-body practices (13). Of the 42 studies, 22 demonstrated a statistically significant, positive impact on sleep and represented each of the categories. The quality of the studies varied considerably, with 17 studies classified as strong, 17 as moderate, and 8 as weak.
Several interventions have been demonstrated to improve sleep in these patients. However, the small number of studies and wide variation of individual interventions within each category limit the generalizability of findings. Further studies are needed to assess interventions and determine effectiveness and acceptability.
睡眠碎片化在患有晚期重病的人群中很常见。改善睡眠的非药物干预措施如果有任何不良反应，通常也很少，并且在这些情况下经常未被充分利用。
我们旨在总结与改善晚期重病成人睡眠的非药物干预措施相关的文献。
我们系统地在六个电子数据库中搜索了在 1996 年至 2016 年期间报告与非药物干预措施相关的睡眠结果的文献，这些文献包括患有晚期重病的参与者。
在总共 2731 个结果中，有 42 项研究符合纳入标准。共确定了 31 项单独的干预措施，每项干预措施都单独进行了评估，有些还与其他干预措施结合进行了评估。这些研究中有 12 项研究在一个干预类别中采用了多种干预措施（n=8），或采用了由两个或多个类别中的干预措施组成的多组分干预措施（n=5）。出现了以下干预类别：睡眠卫生（1）、环境（6）、身体活动（4）、补充健康实践（11）和身心实践（13）。在这 42 项研究中，有 22 项研究显示对睡眠有统计学上显著的积极影响，并且代表了所有类别。研究的质量差异很大，其中 17 项被归类为强，17 项为中，8 项为弱。
一些干预措施已被证明可改善这些患者的睡眠。然而，每项研究的数量较少，并且每个类别中的单个干预措施的差异很大，限制了研究结果的普遍性。需要进一步的研究来评估干预措施并确定其有效性和可接受性。
