博士 / 中山醫學大學 / 醫學研究所 / 101 / The prevalence of Alzheimer’s disease (AD) increased as the population in Taiwan aged rapidly recently. Previous studies have shown that many patients of AD suffered from sleep disturbances. For patients with AD, sleep problems exert an additional burden to the compromised functioning and quality of life. In addition, disrupted sleep in patients with AD is a significant cause of stress for caregivers and frequently leads to institutionalization of patients. For resolution of this problem, the nature of sleep disturbance of AD should be clarified. However, few studies had addressed this issue in Taiwan. The primary aims of present study encompass three parts: (1) to elucidate the prevalence and nature of sleep disturbances and its correlates in community-dwelling patients of AD. (2) to investigate the impact and burden in the caregivers of patients with AD brought by sleep disturbance. (3) to explore the prevalence of primary sleep disorder in patients with AD by the aids of polysomnography.
The present study is a cross-sectional, multi-centers’ study. The study was carried out at Chung Shan Medical University Hospital, Show Chwan Memorial Hospital and Lin Shin Hospital in the period of 2010 to 2012. Eligible criteria of participants are: (1) meet the DSM IV and NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association) criteria as probable or possible AD, (2) dwell in community and live with caregivers, and (3) able to understand and provide written informed consent themselves or provide informed consent by caregivers. The assessment items include cognitive function, self-care function, sleep quality (Pittsburgh Sleep Quality Index), daytime drowsiness (Epworth Sleepiness Scale), threatening life events as well as behavioral and psychological symptoms of dementia (Neuropsychiatric Inventory ; NPI). Mental health and burden of caregivers are also inquired. Fifty-one patients received one-night polysomnographic examination (PSG).
A total of 392 participants were recruited. Among them, 103 persons (26.3%) were in early stage of dementia; 177 persons (45.2%) were categorized as mild dementia, 104 persons (26.5%) as moderate dementia and 8 persons as severe dementia. Two hundred and fifty seven participants (65.6%) suffered from a variety degree of sleep disturbances by NPI assessment, the frequency and severity of sleep disturbances in patients of AD increased as the severity of dementia progressed. Using Pittsburgh Sleep Quality Index to assess sleep quality of AD patients, the prevalence and severity of sleep disturbances were relatively low in mild dementia. As dementia progressed, the impact of sleep disturbances got worse. Patients themselves rated better self-health enjoyed better sleep quality. The determining factors of worse sleep quality included women, poor self-care functioning and greater depressive tendency. Poor sleep efficiency and severe daytime drowsiness were correlated with worsening dementia degree. Increased daytime drowsiness was associated with more depressive tendency and worse cognitive functioning. Nearly ninety percent of patients exhibited at least one item of behavioral and psychological symptoms. There was high comorbidity between sleep disturbance and other behavioral and psychological symptoms in NPI evaluation. Patients with sleep disturbance by NPI assessment demonstrated poorer cognitive functioning, worse daily functioning and more depressive tendency. The burden of caregivers was significantly associated with the caregivers’ distress from sleep disturbances in AD (r=0.267; P<.0001). Besides, caregivers’ burden was highly associated with NPI score (0.452; P<.0001). In the pattern of sleep disturbance, although nighttime wandering and awakening caregivers were not the most prevalent items, they were rated as most distressing experiences by caregivers. Thirty-four percent of caregivers suffered from significant depression in Center for Epidemiologic Studies Depression Scale (CES-D) evaluation. Further effort should be exerted to enhance mental health of caregivers in AD. Of 51 patients receiving PSG examination, the prevalence of sleep apnea was very high (90.2%); followed by periodic limb movement (31.6%).
The prevalence of sleep disturbances in AD patients is very high even in the early stage of illness. As AD illness course progressed, the impact of sleep disturbances got worse. A substantial numbers of AD patients also suffered from primary sleep disorders, mostly sleep apnea and periodic movement disorder. The burden to caregivers brought from sleep disturbance was huge in AD. Further cohort study is needed to elucidate the progression of sleep disturbances in AD as well as its impact on functioning of AD patients.
| Identifer | oai:union.ndltd.org:TW/101CSMU5534063 |
| Date | January 2013 |
| Creators | Po-Ren Teng, 鄧博仁 |
| Contributors | 賴德仁 |
| Source Sets | National Digital Library of Theses and Dissertations in Taiwan |
| Language | zh-TW |
| Detected Language | English |
| Type | 學位論文 ; thesis |
| Format | 149 |
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