Predictors of Response to Insomnia Treatments for Gulf War Veterans

海湾战争退伍军人失眠治疗反应的预测因素

• 批准号: 10201712
• 负责人: JEROME A YESAVAGE
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-10-01 至 2021-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10201712
• 关键词: Address; Aftercare; Ambulatory Care Facilities; Arousal; Beds; Behavior Therapy; Characteristics; Chronic; Clinical Trials; Cognitive; Cognitive Therapy; Collaborations; Communities; Detection; Disease; Doctor of Medicine; Effect Modifiers (Epidemiology); Fatigue; Fibromyalgia; Funding; Germany; Gulf War; Health; Healthcare Systems; Impaired cognition; Individual; Individual Differences; Injury; Lead; Measures; Mediator of activation protein; Medical center; Mental Health; Mental disorders; Methods; Modeling; National Institute of Mental Health; Pain; Patients; Pharmaceutical Preparations; Phase; Polysomnography; Population; Predictive Value; Prevalence; Quality of life; Randomized; Randomized Clinical Trials; Recording of previous events; Reporting; Research; Research Design; Research Project Grants; Risk; Severities; Signal Transduction; Sleep; Sleep Apnea Syndromes; Sleep Architecture; Sleep Disorders; Sleep disturbances; Sleeplessness; Syndrome; Target Populations; Techniques; Testing; Therapeutic Intervention; Thinking; Time; Training; Treatment Efficacy; Variant; Veterans; War; base; chronic pain; clinical center; design; evidence base; experience; follow-up; improved outcome; indexing; optimal treatments; pain perception; personalized medicine; personalized therapeutic; predicting response; pressure; primary outcome; public health relevance; screening; secondary analysis; side effect; sleep quality; sleeping pill; tool; treatment group; treatment response; virtual

 DESCRIPTION (provided by applicant): This application is submitted by Jerome Yesavage, M.D., Director of the VISN 21 Mental Illness Research, Educational and Clinical Center (MIRECC) at the VA Palo Alto Health Care System. The VISN 21 MIRECC has a long research history addressing sleep disorders in Veterans including several research projects on insomnia in Veterans. In recent years over 650 VA mental health clinicians have been trained in CBT-I by the VISN 21 MIRECC. In collaboration with the three War Related Illness and Injury Study Centers (WRIISCs), Dr. Yesavage will focus on Cognitive Behavior Therapy for Insomnia (CBT-I) in Gulf War Veterans (GWVs) attempting to "personalize" CBT-I to the types of insomnia experienced by these Veterans. Components of CBT-I often include both behavioral interventions and cognitive therapy. A commonly used behavioral intervention is Sleep Restriction (SR) designed to reduce "excessive time spent in bed" to the actual amount of the subject's sleep time, thereby increasing sleep pressure that leads to higher quality sleep. Cognitive therapy (CT) for insomnia, like CT for other disorders, focuses on changing intrusive thoughts that interfere with sleep. The primary hypothesis is that the efficacy of these treatments will depend upon an individual subject's baseline characteristics. For SR, we expect that baseline measures of "excessive time spent in bed" may predict response, and for CT, we expect that baseline measures of cognitive arousal and pain may predict response. Exploratory analyses using signal detection techniques will systematically compare and contrast the potential usefulness of a number of additional potential moderator measures. The research will be conducted in two groups of 50 GWVs each. SR and CT will be compared using the Insomnia Severity Index, sleep logs, quality of life measures and relevant mediator and moderator measures. Ultimately the results from this study will allow VA clinicians trained in CBT-I to assign GWV patients to the optimal therapy for their insomnia.

 描述（由申请人提供）： 本申请由 VA Palo Alto 医疗保健系统 VISN 21 精神疾病研究、教育和临床中心 (MIRECC) 主任 Jerome Yesavage 医学博士提交。VISN 21 MIRECC 在解决退伍军人睡眠障碍方面有着悠久的研究历史。近年来，VISN 21 MIRECC 合作对 650 多名 VA 心理健康信徒进行了 CBT-I 培训。 Yesavage 博士将与三个战争相关疾病和伤害研究中心 (WRIISC) 合作，重点研究海湾战争退伍军人 (GWV) 的失眠认知行为疗法 (CBT-I)，试图根据失眠类型“个性化”CBT-I这些退伍军人所经历的 CBT-I 的组成部分通常包括行为干预和认知治疗，其中一种常用的行为干预是睡眠限制 (SR)，旨在减少“过度的睡眠时间”。床“到受试者的实际睡眠时间，增加睡眠压力，从而带来更高质量的睡眠。针对失眠的认知疗法（CT）与针对其他疾病的认知疗法一样，重点是改变干扰睡眠的侵入性想法。主要假设这些治疗的效果将取决于个体受试者的基线特征，对于 SR，我们预计“卧床时间过长”的基线测量可以预测反应，而对于 CT，我们预计认知唤醒和疼痛的基线测量。可以预测使用信号检测技术的探索性分析将系统地比较和对比许多其他潜在调节措施的潜在有用性。该研究将在两组中进行，每组 50 个 GWV，并使用失眠严重程度指数进行比较。最终，这项研究的结果将使接受过 CBT-I 培训的 VA 爱好者能够为 GWV 患者分配针对失眠的最佳治疗方案。