Characterization of sleep with trauma nightmares using ambulatory sleep measurement

使用动态睡眠测量来描述创伤噩梦的睡眠特征

• 批准号: 10409711
• 负责人: Katherine Elizabeth Miller
• 金额: --
• 依托单位: PHILADELPHIA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10409711
• 关键词: Accelerometer; Address; Aftercare; Arousal; Attention; Attenuated; Behavioral; Biological Markers; Body Surface; Caring; Chest; Clinical; Clinical Research; Clinical Sciences; Cognitive; Cognitive Therapy; Data; Detection; Environment; Event; Evidence based treatment; Exclusion; Frequencies; Functional disorder; Goals; Home; Home environment; Intervention; Knowledge; Laboratories; Mattresses; Measures; Methodology; Methods; Monitor; Movement; Nightmare; Outcome; Parasympathetic Nervous System; Participant; Pattern; Physiological; Polysomnography; Post-Traumatic Stress Disorders; Procedures; Quality of life; REM Sleep; Randomized; Relaxation; Reporting; Research; Research Methodology; Sampling; Severities; Signal Transduction; Sinus Arrhythmia; Sleep; Sleep Apnea Syndromes; Sleep Stages; Sleep disturbances; Sleeplessness; Symptoms; System; Time; Training; Trauma; Veterans; actigraphy; active method; candidate marker; career; clinical care; clinically significant; design; eligible participant; evidence base; evidence based guidelines; follow up assessment; improved; multimodality; personalized medicine; personalized strategies; phenomenological models; phenotypic biomarker; physical conditioning; poor sleep; research and development; respiratory; response; sensor; sleep physiology; substance use; suicidal behavior; suicidal risk; symptom management; trauma exposure; traumatic stress; treatment comparison; treatment planning; treatment research; treatment response

Nearly 90% of trauma-exposed Veterans report clinically significant insomnia and/or trauma-related nightmares. Added to the impact on posttraumatic stress disorder (PTSD), trauma-related nightmares have a negative effect on physical health, substance use, and suicidal behaviors. There is a critical need for continued research to better understand these phenomena with the goal of developing personalized treatment plans. Limitations of current assessment procedures present a significant barrier to improved care. In-laboratory sleep studies rarely capture nightmares and cannot assess change over time, reducing our knowledge of phenotypic markers of nightmares to guide treatment. Therefore, there is a need to assess sleep over multiple nights in the home environment, where nightmares occur. The proposed Clinical Sciences Research and Development CDA-2 aims to significantly enrich knowledge about trauma-related nightmares by using a zero-burden, multi- night, objective sleep measurement method within Veterans’ usual sleeping environment prior to and during an evidence-based cognitive-behavioral intervention for nightmares. This study has two primary aims: 1) to identify, with greater precision than previously possible, objective features of sleep associated with trauma- related nightmare occurrences; and 2) to use the treatment for nightmares as interventional probes to determine whether and how changes in sleep physiological parameters identified in Aim 1 covary with changes in subjective nightmare frequency and severity. The study will include 80 trauma-exposed Veterans reporting with trauma-related nightmares. Eligible participants will monitor their sleep for a week using a multi-night mattress actigraphy implemented in their home. Mattress actigraphy, which measures movements using accelerometers embedded in a mattress topper, employs no body surface sensors. Therefore, this system represents a truly zero-burden method for obtaining intensive longitudinal sleep measurement. During the week of sleep monitoring, participants also will complete one-night of polysomnography (PSG) sleep assessment to calibrate the actigraphic sleep efficiency. These methods will be used to investigate candidate physiological parameters associated with trauma-related nightmares. After establishing the levels of these candidate markers, this project will assess the impact of a cognitive-behavioral treatment, Exposure, Relaxation, and Rescripting Therapy (ERRT), on the subset of markers which can be measured continuously over the course of the treatment. Participants will be randomized to five weeks of active treatment (ERRT; n = 40) or to five weeks of the comparison treatment (sleep and nightmare management; n = 40). Throughout the course of treatment, participants will continue to sleep while monitored by the mattress actigraphy system. Upon completion of treatment, a post-treatment and follow-up assessment will assess subjective symptom change. Results from this CDA-2 will provide important information to facilitate increased understanding of the phenomenology, pathophysiology, and treatment of nightmares in trauma-exposed Veterans. This CDA-2 also will provide the applicant with focused training in sleep physiology, advanced longitudinal statistical designs and treatment research methods, and grantsmanship to prepare for a successful VA research career focused on improving the quality of life for Veterans with trauma-related sleep disturbances.

近90％暴露于创伤的退伍军人报告临床上的失眠和/或创伤有关 噩梦。除了对创伤后应激障碍（PTSD）的影响外，与创伤相关的噩梦还具有 对身体健康，使用物质和自杀行为的负面影响。迫切需要继续 研究以制定个性化治疗计划的目标，以更好地理解这些现象。 当前评估程序的局限性提出了改善护理的重大障碍。实验室睡眠 研究很少捕捉噩梦，无法随着时间的推移评估变化，从而减少了我们对表型的了解 噩梦的标记以指导治疗。因此，有必要在多个晚上评估睡眠 噩梦发生的家庭环境。拟议的临床科学研发 CDA-2的目的是通过使用零责任的多重，多重的，多重的 夜晚，在退伍军人通常和期间，老兵通常的睡眠环境中的客观睡眠测量方法 基于证据的噩梦认知行为干预。这项研究有两个主要目的：1） 比以前更能确定与创伤相关的睡眠的客观特征 相关的噩梦发生； 2）将治疗用作噩梦作为介入问题 确定在AIM 1 COVARY中确定的睡眠物理参数的变化以及如何随变化的变化 在主观的噩梦中频率和严重性。 该研究将包括80名与创伤相关的噩梦的暴露于创伤的退伍军人报告。有资格的 参与者将使用在其中实施的多晚床垫行动摄影来监视他们的睡眠一周 家。床垫行动摄影，它使用嵌入床垫中的加速度计测量运动 顶级，员工没有身体表面传感器。因此，该系统代表了一种真正的零负担方法 获得密集的纵向睡眠测量。在睡眠监测的一周中，参与者也将 完整的一晚多渗透学（PSG）睡眠评估，以校准Actraphic睡眠效率。 这些方法将用于研究与创伤有关的候选生理参数 噩梦。确定这些候选标记的水平后，该项目将评估 认知行为待遇，暴露，放松和重试疗法（errt） 可以在治疗过程中连续测量的标记。参与者将是随机的 到五周的主动治疗（errt; n = 40）或比较治疗的五周（睡眠和 噩梦管理； n = 40）。通过治疗过程，参与者将继续入睡 由床垫行为系统监视。治疗完成后，治疗后和随访 评估将评估主观症状的改变。 该CDA-2的结果将提供重要信息，以促进对 现象学，病理生理学和噩梦中噩梦的治疗。此CDA-2也是如此 将为申请人提供睡眠生理学，高级纵向统计设计的重点培训 和治疗研究方法和赠款技巧，为成功的VA研究职业做准备 关于改善与创伤相关睡眠障碍的退伍军人的生活质量。