GCRC Success Story

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GCRC Success Story

• Catherine S. Cole DNSc, APRN, BC
• Assistant Professor
• College of Nursing/UAMS

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Turtle on a Fencepost?
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(No Transcript)
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Sleep Fragmentation and Attention in Persons
with Alzheimers Disease

• Hartford Postdoctoral Fellow
• GCRC Pilot Funds
• Beverly Healthcare Corporation
• Hartford Faculty Research Scholar
• CON Intramural Grant
• K23 Career Development Award (NIH)
• TBIRC Pilot Funds

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Sleep and Functional Status.

• Purpose
• Describe the relationship of sleep to functional
  status.
• Method
• Two nights of polysomnography (n 25) in the
  nursing home.
• Functional status (Nursing Home Physical
  Performance Test).
• Findings
• Mean Age 83.4, MMSE13.2
• Mean time in bed 528.7 (sd56.4)
• Total sleep time 369.6 (sd73.7)
• Mean number of spontaneous wakings was 14.8
  (sd6.5)
• Correlations between functional status
• time in bed (p.011)
• total sleep time (p.010)
• Participants with ? time in bed and ?minutes of
  nighttime sleep demonstrated ?function. Support
  John A Hartford Foundation R01NRAG07771.

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What effect does disturbed sleep have on
cognition in persons with AD?

• In about 23 of persons with AD neuronal
  deterioration results in behavioral state
  instability.
• ?Nighttime wakefulness.
• ?Daytime alertness.
• Impaired cognition.
• Could disturbed sleep from other causes have
  additive adverse effects on cognition?
• How can we separate the confound of Alzheimers
  disease and disturbed sleep on cognition?

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Sleep Cognition in Residents of Long Term Care
(Feasibility)

• Specific Aims
• Describe sample
• Well characterized sample?
• Dementia severity?
• MMSE gt 15?
• Describe sleep disturbances.
• Method
• Secondary data analysis.

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Findings

• Specific Aim 1
• 80 participants in the dataset at the time of
  analysis.
• 57 unspecified dementia.
• 23 AD.
• Mean MMSE 12.
• No severity rating.
• Specific Aim 2
• Mean minutes of nighttime sleep 369.83.
• Mean sleep efficiency was 71.
• Mean 46.3 awakenings per night.

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Conclusions

• Although sleep fragmentation is a striking
  problem in long term care facilities, it was not
  feasible to study sleep and attention in this
  setting due to difficulties in recruiting a well
  defined sample and measuring attention in persons
  with more severe AD.

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Feasibility Study Sleep and Cognition in the
Community

• Specific Aims
• Evaluate feasibility of the community setting.
• Methods
• Secondary analysis.
• Findings
• Frequently disrupted sleep due to environmental
  factors
• pets
• ringing telephones
• electrical interference (60 Hertz)
• family members presence reduced anxiety.
• Conclusions
• It would be preferable to conduct the proposed
  study in a controlled laboratory environment with
  a caregiver in attendance.

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GCRC Protocol 0405 Tone Induced Sleep
Fragmentation

• This experiment was designed to mimic 1 type of
  sleep fragmentation seen in long term care
  facilities due to environmental noise.
• Tones (via audiometer) were repeated periodically
  throughout the night to cause the participant to
  awaken (limited to 85 decibels).
• Cognition was measured before and after 1 night
  of sleep fragmentation.

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Questions

• 1) Will people with AD tolerate the earphone
  needed for the tone-induced sleep fragmentation
  method?
• 2) Can a sleep technician recognize awakenings
  and arousals after tones in real time?
• 3) What percent of tones produce an awakening?
• 4) What percent of persons with AD can complete
  the cognitive tests?

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The Effect of Sleep Fragmentation on Attention in
Persons with AD (PWAD).

• Specific aims
• Pilot an experimental method using sound to
  induce sleep fragmentation in PWAD.
• Design
• Repeated measures.
• Results
• Tones 33 / Behavioral awakenings 27.
• Tones from 70-85 dB produced arousals.

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Data Collection Schedule
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Participants
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Participants Sleep
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Sleep Fragmentation
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Findings

• 1) People with AD were able to tolerate the
  earphone.
• 2) We were able to score a sleep study in real
  time.
• 3) Only approximately 50 of the tones resulted
  in awakenings.
• 4) 100 of the participants were able to complete
  the cognitive tests.

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Additional questions

• 1) Did we really have good sleepers in this group
  of participants?
• Even self reported good sleepers had an average
  of 31 awakenings on night one of this study.
• The average apnea/hypopnea index was 7.4
• 2) Is subjective report of sleep adequate to
  establish inclusion criteria?
• 3) Should the cut-off for inclusion be lowered to
  an apnea/hypopnea index of 5 instead of 10?

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The Effect of Sleep Fragmentation on Attention in
AD
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Next Steps

• K23
• Sleep Fragmentation and Attention in AD.
• TBIRC Pilot
• Feasibility Study Reaction Time in the Home for
  Persons with Alzheimers Disease.
• R15 AREA Submitted
• Feasibility Study Attention Measures in Persons
  with Alzheimers Disease.