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目的 观察不同光照时间全光谱治疗对阿尔茨海默病(Alzheimer’s disease,AD)患者睡眠障碍的临床疗效和安全性.方法 将127例AD伴发睡眠障碍的患者按随机数字表法分为空白组34例、30min光照组31例、60 min光照组33例和120 min光照组29例,通过10 000 lux全光谱光照治疗1个月后,采用匹兹堡睡眠质量指数量表(PQSI)、爱泼沃斯嗜睡量表(ESS)、神经精神问卷(NPI)、简易智能状态量表(MMSE)和总体衰退量表(GDS)等评分作为主要评价指标,比较光照前后患者的睡眠质量、日间过度嗜睡、认知功能、精神状况和痴呆程度的变化.结果 (1)与治疗前相比,30 min组、60 min组和120 min组的PQSI,ESS,NPI评分差异有统计学意义[30 min组:(14.4±5.2)分vs(11.7±4.9)分,(14.4±4.1)分vs(11.8±3.7)分,(14.2±1.3)分vs(10.9±1.7)分,t=2.071,2.609,8.446,P=0.043,0.011,0.000.60 min组:(13.4±4.0)分vs(8.1±3.7)分,(14.5±3 0)分vs(9.4±2.0)分,(13.7±5.8)分vs(8.7±4.3)分,t=5.650,8.209,3.902,均P＜0.01.120 min组:(14.0±3.2)分vs(7.0±2.3)分,(14.7±2.3)分vs(7.0±1.9)分,(14.9±3.6)分vs(8.1±3.7)分,t=9.474,13.926,7.062,均P＜0.01],MMSE,GDS评分差异无统计学意义(均P＞0.05).(2)与空白组相比,30 min组、60 min组和120 min组的PQSI,NPI,ESS评分差异有统计学意义(30 min组:t=1.936,4.524,2.482,P=0.031,0.000,0.016. 60 min组:t=5.945,5.153,7.319,均P=0.000. 120 min组:t=7.896,6.767,10.776,均P=0.000),MMSE,GDS评分差异无统计学意义(均P＞0.05).(3)与30 min组相比,60 min组和120 min组PQSI,NPI,ESS评分差异有统计学意义(60 min组:t=3.288,2.694,3.354,P=0.002,0.009,0.001.120 min组:t=4.615,3.930,6 303,均P=0.000).MMSE,GDS评分差异无统计学意义(均P＞0.05);与60 min组相比,120 min组的ESS评分差异有统计学意义(t=4.854,P=0.000),PQSI、NPI、MMSE、GDS评分差异无统计学意义(均P＞0.05).各光照组不良反应发生率与空白组相比差异无统计学意义(均P＞0.05).结论 光照疗法能有效改善AD患者睡眠质量、日间过度嗜睡、神经精神症状,而且光照时间60min和120 min优于30 min,光照时间120 min改善日间过度嗜睡优于60 min;光照疗法对AD患者的认知能力及痴呆程度没有明显的影响,治疗过程中未出现明显不良反应.“,”Objective To evaluate the clinical efficacy and safety of different full spectrum light times in treating patients with Alzheimer’s disease (AD).Methods A total of 127 AD patients with sleep disorder were randomly divided into a blank group (n=34),a 30 min group (n=31),a 60 min group (n=33) and a 120 min group (n=29).After one month treatment by 10 000 lux full spectrum fluorescent light,the improvements of sleep quality,excessive daytime sleepiness,cognitive ability,mental state,dementia degree were graded by Pittsburgh sleep quality index (PQSI),Epworth sleepiness scale (ESS),Neuropsychiatric inventory (NPI),mini-mental state examination (MMSE),global deterioration scale (GDS).The scores were compared among the groups before the treatment and after the treatment respectively.Results (1) Compared with before treatment,the scores of PQSI,ESS,NPI of the 30 min group,60min group and 120min group were statistically significant (in 30 min group 14.4 ±5.2vs 11.7±4.9,14.4±4.1 vs 11.8±3.7,14.2±1.3 vs 10.9±1.7,t=2.071,2.609,8.446.P=0.043,0.011,0.000; in 60 min group13.4±4.0 vs 8.1±3.7,14.5±3.0 vs 9.4±2.0,13.7±5.8 vs 8.7±4.3,t=5.650,8.209,3.902,all P＜0.01 ;in 120 min group 14.0±3.2 vs 7.0±2.3,14.7-±2.3 vs 7.0± 1.9,14.9±3.6 vs 8.1±3.7,t=9.474,13.926,7.062,all P＜0.01),but the scores of MMSE,GDS were not statistical significances(all P＞0.05).(2)Compared with the blank group,the scores of PQSI,ESS,NPI of 30 min group,60 min group and 120 min group were statistically significant (30 min group t=1.936,4.524,2.482,P=0.031,0.000,0.016.60 min group t=5.945,5.153,7.319,all P=0.000.120 min group t=7.896,6.767,10.776,all P=0.000), but the scores of MMSE,GDS were not statistical significances(all P＞0.05).(3)Compared with the 30 min group,the scores of PQSI,ESS,NPI of 60 min group and 120 min group were statistically significances (60 min group t =3.288,2.694,3.354,P=0.002,0.009,0.001.120 min group t=4.615,3.930,6.303,all P =0.000),the scores of MMSE,GDS were not statistical significances (all P＞0.05).Compared with the 60 min group,the scores of ESS of 120 min group was statistically significant(t=4.854,P=0.000),but the scores of PQSI,NPI,MMSE,GDS were not statistical significances (all P ＞ 0.05).Conclusion It is demonstrated good curative effects that light therapy treat patients on AD patients in the matter of sleep quality,excessive daytime sleepiness,mental state,but have not apparent effect for their cognitive ability and dementia degree.And the effect of light therapy with 60 or 120 minutes is better than that of 30 minute,illumination time of 120 minutes is superior to that of 60 minutes in improving excessive daytime sleepiness.Light therapy has no obvious impacts in the cognitive ability and the degree of dementia in the patients with AD and has not appear obvious adverse reaction in the process of treatment.