Nurs Res. 2021;70(4):310-316. doi: 10.1097/NNR.0000000000000506.
Older adults with mild cognitive impairment are at an increased risk for dementia of the Alzheimer's type. These older adults also report poorer sleep and more pain than their cognitively intact adult counterparts. Poor sleep and pain are both symptoms associated with an increased risk for dementia in later life. Symptom science research in the direction of how poor sleep affects pain among older adults, especially those with mild cognitive impairment, is needed for the development of targeted sleep interventions to reduce pain and potentially delay/reduce the risk for Alzheimer's disease in this population.
The aim of the study was to examine a predictive model of the relationship between poor sleep and pain perception among community-dwelling older adults with mild cognitive impairment.
A longitudinal prospective design with 58 continuous matched sleep-pain observations of 15 older adults with mild cognitive impairment for up to 6 months was used. Multilevel, mixed-modeling, statistical techniques were used to examine the effects of prior-week sleep on subsequent pain perception. Pain perception (pain intensity, pain interference, and pain behavior) is measured by the Patient-Reported Outcomes Measurement Information System during monthly in-person visits. The ActiGraph GT3X+ was used to measure sleep (total sleep time, sleep efficiency, awakenings after sleep onset) objectively and continuously for up to 6 months, along with other covariates (e.g., physical activity).
Increased awakenings after sleep onset in the prior week is associated with increased pain intensity, pain interference, and pain behavior. There was a trend toward sleep efficiency, and increased pain intensity and sleep efficiency predicted increased pain interference and pain behavior. There was no relationship between prior-week total sleep time and subsequent pain perception.
In this study, poor sleep in the prior week increased pain intensity, pain interference, and pain behavior. Interventions designed to decrease awakening after sleep onset and increase sleep efficiency specifically may effectively reduce pain in this population. Given that these symptoms are prevalent among older adults with mild cognitive impairment, sleep and pain interventions may also ameliorate some of the risk for Alzheimer's disease in this population.
轻度认知障碍的老年人患阿尔茨海默病型痴呆的风险增加。这些老年人的睡眠质量比认知正常的成年人差，疼痛也更多。睡眠质量差和疼痛都是与晚年痴呆风险增加相关的症状。需要开展症状科学研究，以了解睡眠质量差如何影响老年人的疼痛，尤其是那些有轻度认知障碍的老年人，从而制定有针对性的睡眠干预措施来减轻疼痛，并有可能降低该人群患阿尔茨海默病的风险。
本研究旨在检验一个预测模型，即社区居住的轻度认知障碍老年人睡眠质量差与疼痛感知之间的关系。
采用 15 名轻度认知障碍老年人长达 6 个月的 58 次连续匹配睡眠-疼痛观察的纵向前瞻性设计。采用多级混合模型统计技术来检验前一周睡眠对后续疼痛感知的影响。疼痛感知（疼痛强度、疼痛干扰和疼痛行为）通过患者报告的结果测量信息系统在每月的当面访视中进行测量。ActiGraph GT3X+ 用于客观、连续地测量长达 6 个月的睡眠（总睡眠时间、睡眠效率、睡眠起始后觉醒次数），并测量其他协变量（如体力活动）。
前一周睡眠起始后觉醒次数增加与疼痛强度、疼痛干扰和疼痛行为增加有关。睡眠效率呈增加趋势，疼痛强度和睡眠效率增加预测疼痛干扰和疼痛行为增加。前一周总睡眠时间与随后的疼痛感知之间没有关系。
在这项研究中，前一周的睡眠质量差增加了疼痛强度、疼痛干扰和疼痛行为。专门设计用于减少睡眠起始后觉醒次数和增加睡眠效率的干预措施可能会有效减轻该人群的疼痛。鉴于这些症状在轻度认知障碍的老年人中很常见，睡眠和疼痛干预措施也可能改善该人群患阿尔茨海默病的一些风险。
