Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Prestwich, Manchester, UK.
Surrey Sleep Research Centre, University of Surrey, Guildford, UK; UK Dementia Research Institute, London, UK.
Sleep Health. 2020 Oct;6(5):690-701. doi: 10.1016/j.sleh.2020.01.014. Epub 2020 Mar 12.
Sleep problems and circadian misalignment affect health and well-being and are highly prevalent in those with co-morbid neuropsychiatric disorders. Interventions altering light exposure patterns of affected individuals are a promising non-pharmacological treatment option, shown by previous meta-analyses to improve sleep, and often described as minimally invasive. To best translate laboratory-based mechanistic research into effective treatments, acceptability and barriers to adherence should be understood, but these have not yet been systematically evaluated. Here, we examined evidence regarding adherence and acceptability in studies of light or dark interventions using various delivery devices and protocols to improve sleep in intrinsic circadian rhythm sleep-wake disorders and neuropsychiatric illness. Attrition during intervention was low, and reported experiences were largely positive, but measurement and reporting of self-reported experiences, expectations, and adverse effects were poor. Approaches to management and measurement of adherence were varied, and available light monitoring technology appeared under-exploited, as did mobile technology to prompt or track adherence. Based on these findings we suggest recommended reporting items on acceptability and adherence for future investigations. Few studies assessed baseline light exposure patterns, and few personalised interventions. Overall, many applied studies exhibited an approach to light schedule interventions still reminiscent of laboratory protocols; this is unlikely to maximise acceptability and clinical effectiveness. For the next phase of translational research, user acceptability and adherence should receive increased attention during intervention design and study design. We suggest framing light therapies as complex interventions, and emphasise the occupationally embedded (daily activity routine embedded) context in which they occur.
睡眠问题和昼夜节律失调会影响健康和幸福感，在患有合并神经精神疾病的人群中更为普遍。改变受影响个体光照暴露模式的干预措施是一种有前途的非药物治疗选择，先前的荟萃分析表明，这种干预措施可以改善睡眠，并且通常被描述为微创。为了将基于实验室的机制研究最好地转化为有效的治疗方法，应该理解可接受性和坚持治疗的障碍，但这些尚未得到系统评估。在这里，我们研究了使用各种输送设备和方案进行的光或暗干预研究中关于坚持治疗和可接受性的证据，以改善内在昼夜节律睡眠-觉醒障碍和神经精神疾病的睡眠。干预期间的退出率较低，报告的经验大多是积极的，但自我报告的经验、期望和不良反应的测量和报告很差。坚持治疗的管理和测量方法多种多样，可用的光照监测技术似乎没有得到充分利用，用于提示或跟踪坚持治疗的移动技术也是如此。基于这些发现，我们建议为未来的研究提供关于可接受性和坚持治疗的推荐报告项目。很少有研究评估基线光照暴露模式，也很少有个性化干预措施。总的来说，许多应用研究对光照时间表干预的方法仍然类似于实验室方案；这不太可能最大限度地提高可接受性和临床效果。在转化研究的下一阶段，干预设计和研究设计中应更加关注用户可接受性和坚持治疗。我们建议将光照疗法视为复杂干预措施，并强调它们发生的职业嵌入（日常活动常规嵌入）背景。
