光照疗法对痴呆患者睡眠、抑郁、神经精神行为和认知的影响：随机对照试验的荟萃分析。
The Effects of Light Therapy on Sleep, Depression, Neuropsychiatric Behaviors, and Cognition Among People Living With Dementia: A Meta-Analysis of Randomized Controlled Trials.
机构信息
School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Nursing Department, Faculty of Health Sciences (NA), University of Muhammadiyah Malang, Indonesia.
School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Department of Nursing (RC, HJJ, KRC), Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Post-Baccalaureate Program in Nursing (RC), College of Nursing, Taipei Medical University, Taipei, Taiwan.
出版信息
Am J Geriatr Psychiatry. 2024 Jun;32(6):681-706. doi: 10.1016/j.jagp.2023.12.010. Epub 2023 Dec 23.
OBJECTIVE
Alterations in the suprachiasmatic nucleus due to underlying pathologies disrupt the circadian rhythms in people living with dementia (PLWD). Circadian rhythms significantly impact sleep, emotional, and cognitive functions, with its synchronization depending on light exposure. We performed a meta-analysis to evaluate the effects of light therapy on sleep, depression, neuropsychiatric behaviors, and cognition among PLWD.
METHODS
A systematic search was conducted in Cochrane, ClinicalTrials.gov, Embase, EBSCOhost, Ovid-MEDLINE, PubMed, Scopus, Web of Science, and CINAHL databases. The pooled effect size was calculated using the Hedges' g with random-effects model adopted in comprehensive meta-analysis software. The Cochrane risk of bias (RoB 2.0) tool evaluated the quality of studies, while Cochrane's Q and I² tests assessed heterogeneity.
RESULTS
A total of 24 studies with 1,074 participants were included. Light therapy demonstrated small-to-medium effects on improving sleep parameters: total sleep time (Hedges' g = 0.19), wake after sleep onset (Hedges' g = 0.24), sleep efficiency (Hedges' g = 0.31), sleep latency (Hedges' g = 0.35), circadian rhythm (acrophase: Hedges' g = 0.36; amplitude: Hedges' g = 0.43), number of night awakenings (Hedges' g = 0.37), sleep disturbance (Hedges'g = 0.45), and sleep quality (Hedges' g = 0.60). Light therapy showed small-to-medium effect on reducing depression (Hedges' g = -0.46) with medium-to-large effect on cyclical function (Hedges' g = -0.68) and mood-related signs and symptoms (Hedges' g = -0.84) subscales. Light therapy also demonstrated small effect on reducing neuropsychiatric behaviors (Hedges' g = -0.34) with medium-to-large effect on agitation (Hedges' g = -0.65), affective symptom (Hedges' g = -0.70), psychosis (Hedges' g = -0.72), and melancholic behavior (Hedges' g = -0.91) subscales. Additionally, light therapy also improved cognition (Hedges' g = 0.39).
CONCLUSION
Light therapy could be used as a supportive therapy to improve sleep, depression, cognition, and neuropsychiatric behaviors among PLWD.
目的
由于潜在的病理变化，视交叉上核的改变会破坏痴呆患者（PLWD）的昼夜节律。昼夜节律对睡眠、情绪和认知功能有重大影响，其同步取决于光照。我们进行了一项荟萃分析，以评估光疗对 PLWD 的睡眠、抑郁、神经精神行为和认知的影响。
方法
在 Cochrane、ClinicalTrials.gov、Embase、EBSCOhost、Ovid-MEDLINE、PubMed、Scopus、Web of Science 和 CINAHL 数据库中进行了系统检索。使用综合荟萃分析软件中的 Hedges' g 随机效应模型计算汇总效应大小。使用 Cochrane 风险偏倚（RoB 2.0）工具评估研究质量，同时使用 Cochrane 的 Q 和 I²检验评估异质性。
结果
共有 24 项研究纳入了 1074 名参与者。光疗对改善睡眠参数具有小到中等的效果：总睡眠时间（Hedges' g = 0.19）、睡眠后觉醒（Hedges' g = 0.24）、睡眠效率（Hedges' g = 0.31）、睡眠潜伏期（Hedges' g = 0.35）、昼夜节律（峰值：Hedges' g = 0.36；幅度：Hedges' g = 0.43）、夜间觉醒次数（Hedges' g = 0.37）、睡眠障碍（Hedges' g = 0.45）和睡眠质量（Hedges' g = 0.60）。光疗对降低抑郁（Hedges' g = -0.46）有小到中等的效果，对周期性功能（Hedges' g = -0.68）和与情绪相关的体征和症状（Hedges' g = -0.84）子量表有中到大的效果。光疗对降低神经精神行为（Hedges' g = -0.34）也有小的效果，对激越（Hedges' g = -0.65）、情感症状（Hedges' g = -0.70）、精神病（Hedges' g = -0.72）和忧郁行为（Hedges' g = -0.91）子量表有中到大的效果。此外，光疗还改善了认知（Hedges' g = 0.39）。
结论
光疗可以作为一种辅助疗法，改善痴呆患者的睡眠、抑郁、认知和神经精神行为。
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