Higami Yoko, Takeya Yasushi, Takemura Yukihiro, Oguro Ryosuke, Katsuma Kumiko, Matsukawa Naomichi, Rakugi Hiromi, Kamide Kei
Department of Nursing, Osaka Medical and Pharmaceutical University.
Division of Health Sciences, Osaka University Graduate School of Medicine.
Nihon Ronen Igakkai Zasshi. 2022;59(2):200-208. doi: 10.3143/geriatrics.59.200.
The purpose of this study was to objectively quantify the sleep of elderly patients with dementia at home using a device and to investigate the factors associated with its identification.
Sixteen patients (6 males [37.5%], 84.1±4.7 years old; and 10 patients with mild dementia [62.5%]) and their family caregivers who were using outpatient memory clinics and home-visiting nursing station in Japan were included. Demographic and clinical data of the patients and their family caregivers, subjective perceptions of patients' sleep, family caregivers' Zarit care burden, and whether or not they were aware of patients' sleep problems were determined. Nighttime sleep parameters were collected for one week using a non-wearable actigraph. Sleep parameters were compared with patients' subjective views and family caregivers' observations to investigate factors indicative of sleep disturbance.
Nighttime sleep parameters for 1 week (mean) were follows: sleep efficiency, 77.2%±9.3%; asleep time, 442.3±99.9 minutes; sleep latency, 18.2±15.8 minutes; awake time, 105.1±69.7 minutes; and number of times leaving the bed, 4.6±3.8 (maximum of 29/night). A significant positive correlation was found between sleep efficiency and duration of dementia (r=0.53, p=0.046), while no correlation was found with dementia severity or Zarit care burden score. The agreement between the patients' complaints about sleep and sleep efficiency (75%) was 30.7%, and family caregivers' awareness of patients' nighttime awakening and bed-leaving was significantly associated with patients' incontinence (p=0.024) and a greater dementia severity (p=0.027).
Elderly dementia patients experienced sleep disturbance at home, such as nighttime awakening and associated bed-leaving; however, it might be difficult to identify these patients at an early stage based on their own complaints and observations by family caregivers. Identifying sleep problems at an early stage may thus require the use of objective measurement devices.
本研究旨在使用一种设备客观量化居家老年痴呆患者的睡眠情况，并调查与其识别相关的因素。
纳入了16名患者（6名男性[37.5%]，84.1±4.7岁；10名轻度痴呆患者[62.5%]）及其在日本使用门诊记忆诊所和上门访视护理站的家庭照顾者。确定了患者及其家庭照顾者的人口统计学和临床数据、患者对睡眠的主观感受、家庭照顾者的扎里特照顾负担以及他们是否意识到患者的睡眠问题。使用非穿戴式活动记录仪收集一周的夜间睡眠参数。将睡眠参数与患者的主观看法和家庭照顾者的观察结果进行比较，以调查表明睡眠障碍的因素。
1周的夜间睡眠参数（平均值）如下：睡眠效率，77.2%±9.3%；入睡时间，442.3±99.9分钟；睡眠潜伏期，18.2±15.8分钟；清醒时间，105.1±69.7分钟；下床次数，4.6±3.8次（最多29次/晚）。发现睡眠效率与痴呆持续时间之间存在显著正相关（r=0.53，p=0.046），而与痴呆严重程度或扎里特照顾负担评分无关。患者对睡眠的抱怨与睡眠效率之间的一致性（75%）为30.7%，家庭照顾者对患者夜间觉醒和下床的认知与患者的失禁（p=0.024）和更严重的痴呆程度（p=0.027）显著相关。
老年痴呆患者在家中存在睡眠障碍，如夜间觉醒和相关的下床情况；然而，基于他们自己的抱怨和家庭照顾者的观察，可能难以在早期识别这些患者。因此，早期识别睡眠问题可能需要使用客观测量设备。
