| 摘要: | 研究背景：老年人發生認知功能缺損後產生睡眠障礙盛行率為26~70%，較一般老年人睡眠障礙盛行率高。在考量藥物治療副作用之下，找尋非藥物性治療為首要治療方式，然而，目前對於何種非藥物治療為最有效的治療以改善此族群之睡眠障礙仍不清楚。研究目的：旨在以系統性文獻回顧的方式比較不同非藥物介入措施對於認知功能缺損老年人睡眠障礙的成效。研究設計：隨機臨床試驗之系統性文獻回顧與網絡統合分析。研究方法：本研究利用Pubmed、CINHAL、Embase、Cochrane Central Register of Controlled Trials及ProQuest五個資料庫進行文獻檢索至2023年08月31日，所納入研究不限制語言及年份。兩名研究者進行文獻選讀與資料擷取以及利用考科藍誤差風險評估工具第二版進行文獻品質評估。本研究採頻率分析學派以隨機效應模型進行網絡統合分析。本研究已於國際系統性回顧登記網進行註冊（CRD42023441449）。研究結果：本研究共納入37篇隨機控制試驗，包含11種非藥物介入措施，總樣本數共2,720人，平均年齡為81.09歲，女性比例為67%。考量可納入網絡統合分析的文章數量，僅針對客觀性總睡眠時間、入睡後清醒時間、睡眠效率、入睡潛伏期，以及主觀性睡眠品質進行報導。與控制組相比，照光治療後的睡眠效率可增加6.12%（95% Confidence interval [CI] = 2.08 to 10.17）；與控制組及音樂介入相比，多模式介入治療可各別減少入睡後清醒時間約36.00分鐘與56.50分鐘（95% CI = -67.57 to -4.43與-106.65 to -6.35）。P-score結果顯示照光治療為客觀睡眠效率治療排名上之最佳方式（0.76），於入睡後清醒時間之治療排名則是多模式介入治療（0.86）為最優。結論與建議：本研究建議可採用照光治療以提高認知功能障礙老年人的睡眠效率；多模式介入方式可有效減少此族群之入睡後清醒時間。然而，以目前證據顯示，因多模式介入措施的文章篇數較少，未能確認有效之多模式組合，建議未來研究更深入了解多模式介入治療方式改善此族群的睡眠障礙。
Background: The prevalence of sleep disturbances in older adults with cognitive deficits ranges from 26% to 70%, which is higher than in the general elderly population. Considering the side effects of pharmacological treatments, non-pharmacological interventions are prioritized; however, the most effective non-pharmacological interventions for improving sleep in this population remain unclear.Purpose: To compare the effects of non-pharmacological interventions for mitigating sleep disturbances in older adults with cognitive deficits.Design: A systematic review and network meta-analysis of randomized controlled trial.Method: We conducted a systematic search of the PubMed, CINAHL, Embase, Cochrane Central Register of Controlled Trials, and ProQuest from their inception to 31 August 2023. No restriction in language and searching period was applied. Two reviewers independently conducted peer-reviewed screening, and evaluated the quality of the included studies using the Revised Cochrane risk of bias tool, 2.0. We used frequentist method random-effects networks in the meta-analysis. The study is registered on the International Prospective Register of Systematic Reviews (CRD42023441449).Result: A total of 37 randomized controlled trials, including 11 non-pharmacological interventions and 2,720 participants with an average age of 81 years old, were included. Females accounted for approximately 67%. Due to the limited number of included studies for network meta-analysis, only objective total sleep time, wake after sleep onset, sleep efficiency, sleep onset latency, and subjective sleep quality were reported. Compared to the control group, light therapy significantly improved sleep efficiency, with an increase of 6.12% (95% Confidence Interval [CI] = 2.08 to 10.17). In comparison with the control group and music intervention, multimodal regimen significantly reduced wake after sleep onset by approximately 36.00 minutes and 56.50 minutes, respectively (95% CI = -67.57 to -4.43 and -106.65 to -6.35). The findings of P-score indicated that light therapy ranked best intervention for improving objective sleep efficiency (0.76), while multimodal regimen ranked highest for reducing wake after sleep onset (0.86).Conclusion: Light therapy is suggested for enhancing sleep efficiency, whereas multimodal therapy is considered a relatively superior intervention for reducing wake after sleep onset. However, for multimodal therapy, the most effective combination remains inconclusive due to limited study numbers. Future research should include more studies and standardized multimodal treatment formulations for better reference. |
