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Passive Body Heating Ameliorates Sleep Disturbances in Patients With Vascular Dementia Without Circadian Phase-Shifting

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Objective

This study investigated the sleep-promoting, thermoregulatory, and circadian phase-shifting actions of passive body heating (PBH) in elderly insomniac patients (IPs) with mild-to-moderate vascular dementia.

Methods

Thirteen elderly IPs with vascular dementia (mean age 76.9 years; male/female ratio 2/11) were subjected to a PBH trial session. This session comprised a 3-day baseline period, 2-day PBH period, and 1-day post-PBH period. In the PBH period, the subjects received PBH (immersion in hot water about 40.0°C to mid-thorax level) for 30 minutes beginning 2 hours before bedtime. Sleep–waking, estimated by actigraph, core body temperature (cBT), and heart rate variability were continuously monitored. Dim-light melatonin-onset time (DLMO) was determined in the baseline and post-PBH periods.

Results

PBH significantly improved subjects' sleep quality; sleep latency decreased; sleep efficiency increased; and wake time after sleep onset decreased. These trends were more prominent in the latter half of the sleep time. PBH induced a rapid cBT elevation of approximately 0.80°C, on average, followed by enhanced heat loss (ΔcBT: difference in cBT between just after the PBH and bedtime), lasting 1.5 hours before sleep. There was a significantly positive correlation between ΔcBT and sleep latency. PBH induced no significant phase shift in DLMO. Heart-rate variability data showed that PBH induced parasympathomimetic action during sleep time in the subjects.

Conclusion

PBH may have a sleep-promoting effect by intervening in the thermoregulatory and autonomic systems in elderly IPs with vascular dementia.

Section snippets

Participants

Subjects of the present study were 2 men and 11 women over age 70 (mean age, 76.9 years). Informed consent to participate was obtained from each subject or his/her family. All subjects had been residents of the same facility for elderly patients for at least 3 months before participating in the study. They all met DSM-IV criteria for vascular dementia. All subjects underwent brain magnetic resonance imaging; all subjects exhibited multiple lacunes, mainly occurring in basal ganglia, and deep

Effects of PBH on Sleep Quality

Properties of sleep quality in the baseline and PBH periods are shown in Table 1. PBH for 2 consecutive days induced a significant reduction in SL compared with the corresponding values in the baseline period. Changes in TST, SE, and WASO did not reach statistically significant levels. However, when sleep parameters were analyzed separately for the first and second halves of sleep time, repeated-measures ANOVA showed that PBH induced a significant increase in SE (F[2, 36] = 4.42; p = 0.020) and

DISCUSSION

This study provides data indicating that PBH exhibited therapeutic effects on both difficulty in sleep-initiation and decreased sleep-maintenance ability in our study subjects. Despite the shortcoming that this was an open study, the present findings support the notion that PBH could be an effective tool for sleep disturbance in elderly persons with mild vascular dementia, as it was shown to be in elderly IPs without dementia.3 PBH induced an acute and transient cBT elevation of approximately

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    This study was supported by Special Coordination Funds of the Ministry of Education, Culture, Sports, and Technology, and a Grant-in-Aid for Cooperative Research from the Ministry of Health, Labor, and Welfare of Japan.

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