多模式生活方式干预对睡眠和认知功能的影响：一项针对有轻度认知障碍和睡眠不佳的老年人的随机临床试验。

Effect of a Multimodal Lifestyle Intervention on Sleep and Cognitive Function in Older Adults with Probable Mild Cognitive Impairment and Poor Sleep: A Randomized Clinical Trial.

机构信息

Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.

Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.

出版信息

J Alzheimers Dis. 2020;76(1):179-193. doi: 10.3233/JAD-200383.

DOI:10.3233/JAD-200383

PMID:32444553

Abstract

BACKGROUND

Poor sleep is common among older adults with mild cognitive impairment (MCI) and may contribute to further cognitive decline. Whether multimodal lifestyle intervention that combines bright light therapy (BLT), physical activity (PA), and good sleep hygiene can improve sleep in older adults with MCI and poor sleep is unknown.

OBJECTIVE

To assess the effect of a multimodal lifestyle intervention on sleep in older adults with probable MCI and poor sleep.

METHODS

This was a 24-week proof-of-concept randomized trial of 96 community-dwelling older adults aged 65-85 years with probable MCI (<26/30 on the Montreal Cognitive Assessment) and poor sleep (>5 on the Pittsburgh Sleep Quality Index [PSQI]). Participants were allocated to either a multimodal lifestyle intervention (INT); or 2) education + attentional control (CON). INT participants received four once-weekly general sleep hygiene education classes, followed by 20-weeks of: 1) individually-timed BLT; and 2) individually-tailored PA promotion. Our primary outcome was sleep efficiency measured using the MotionWatch8© (MW8). Secondary outcomes were MW8-measured sleep duration, fragmentation index, wake-after-sleep-onset, latency, and PSQI-measured subjective sleep quality.

RESULTS

There were no significant between-group differences in MW8 measured sleep efficiency at 24-weeks (estimated mean difference [INT -CON]: 1.18%; 95% CI [-0.99, 3.34]), or any other objective-estimate of sleep. However, INT participants reported significantly better subjective sleep quality at 24-weeks (estimated mean difference: -1.39; 95% CI [-2.72, -0.06]) compared to CON.

CONCLUSION

Among individuals with probable MCI and poor sleep, a multimodal lifestyle intervention improves subjective sleep quality, but not objectively estimated sleep.

摘要

背景

轻度认知障碍（MCI）的老年人普遍存在睡眠质量差的问题，并且可能导致认知能力进一步下降。目前尚不清楚结合强光疗法（BLT）、身体活动（PA）和良好的睡眠卫生习惯的多模式生活方式干预是否可以改善 MCI 伴睡眠不佳的老年人的睡眠。

目的

评估多模式生活方式干预对 MCI 伴睡眠不佳的老年人睡眠的影响。

方法

这是一项为期 24 周的概念验证随机试验，纳入了 96 名年龄在 65-85 岁之间、有 MCI（蒙特利尔认知评估＜26/30）和睡眠不佳（匹兹堡睡眠质量指数＞5）的社区居住的老年人。参与者被分配到多模式生活方式干预（INT）组或 2）教育+注意力控制（CON）组。INT 组参与者每周接受一次一般性睡眠卫生教育课程，共 4 次，随后接受 20 周的个体化时间 BLT 和个体化量身定制的 PA 促进。我们的主要结局指标是使用 MotionWatch8©（MW8）测量的睡眠效率。次要结局指标是 MW8 测量的睡眠时间、碎片化指数、睡眠潜伏期、睡眠后觉醒时间和匹兹堡睡眠质量指数（PSQI）测量的主观睡眠质量。

结果

在 24 周时，MW8 测量的睡眠效率在 INT 组和 CON 组之间没有显著差异（INT-CON 的估计平均差异：1.18%；95%CI[-0.99，3.34]），也没有其他客观评估的睡眠参数存在差异。然而，与 CON 组相比，INT 组在 24 周时报告的主观睡眠质量明显更好（估计平均差异：-1.39；95%CI[-2.72，-0.06]）。