Sleep-Disordered Breathing and PAP in Perinatal Depression

围产期抑郁症中的睡眠呼吸障碍和 PAP

• 批准号: 8819255
• 负责人: Leslie M Swanson
• 金额: $ 15.39万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-06-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8819255
• 关键词: Address; Adult; Affect; Alabama; Antidepressive Agents; Award; Behavioral; Chronic; Clinical; Clinical Psychology; Clinical Research; Collaborations; Comorbidity; Data; Development; Discipline of obstetrics; Disease remission; Doctor of Medicine; Doctor of Philosophy; Environment; Faculty; Fellowship; Female; Foundations; Funding; Goals; Gynecology; Health; Health Benefit; Hospitalization; Hydrocortisone; Hyperactive behavior; Hypoxia; Infant; Institutes; Intervention; Knowledge; Laboratories; Left; Link; Low Birth Weight Infant; Medicine; Mental Depression; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Michigan; Modeling; Moods; Mothers; Neonatal; Neuroendocrinology; Neurosecretory Systems; Outcome; Pathway interactions; Perinatal; Physiological; Physiology; Plant Roots; Play; Population; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnant Women; Premature Birth; Psychiatrist; Psychiatry; Public Health; Randomized; Randomized Controlled Trials; Recording of previous events; Relative (related person); Reporting; Research; Research Infrastructure; Research Personnel; Resources; Risk; Role; Scientist; Selective Serotonin Reuptake Inhibitor; Shapes; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Sleep Fragmentations; Snoring; Symptoms; Testing; Third Pregnancy Trimester; Time; Training; United States; Universities; Woman; Work; adverse outcome; antepartum depression; clinical practice; depressive symptoms; experience; fetal programming; improved; improved functioning; interest; neurodevelopment; novel; offspring; peripartum depression; pregnant; premature; prenatal; pressure; programs; public health relevance; response; treatment as usual; treatment-resistant depression

 DESCRIPTION (provided by applicant): This Mentored Patient-Oriented Research Career Development Award proposes a program of tailored mentorship, focused research, didactics and coursework to provide the candidate with the training in sleep medicine and perinatal neuroendocrine functioning necessary for independence as an investigator. Candidate. The candidate's background and foundation in clinical research make her well-poised for this award. She completed her Ph.D. in clinical psychology at the University of Alabama, where she received training rooted in the scientist-practitioner model. An emerging interest in sleep and mood led her to pursue a postdoctoral fellowship at the University of Michigan, where she began to develop a niche in behavioral sleep medicine and perinatal mental health. She was recently appointed to the faculty of the Department of Psychiatry at the University of Michigan. Her goal is to receive additional training in sleep medicine and perinatal neuroendocrinology. The candidate has identified two key training objectives necessary to achieve full independence as a researcher: (1) experience in sleep physiology (including assessment and treatment of sleep-disordered breathing in pregnancy) and (2) neuroendocrinology in pregnancy. Environment. The proposed project will take place within the University of Michigan Department of Psychiatry and the Sleep Disorders Center. Both departments have an extensive history of close collaboration with the Department of Obstetrics and Gynecology. The fifth largest research university in the United States, the University of Michigan provides extensive resources and a rich research environment. The candidate will have access to the large, accredited Sleep Laboratory within the Sleep Disorders Center, the well-established perinatal recruitment infrastructure within the Women's Mental Health and Infants Program (in collaboration with the Department of Obstetrics), and resources provided by the CTSA-funded Michigan Institute for Clinical and Health Research. The proposed primary mentor, Ronald Chervin, M.D., M.S., is a well-funded, highly productive expert in sleep-disordered breathing who has more than 20 years of experience in sleep medicine and a long history of mentoring K awardees and junior faculty. Two carefully selected co-mentors, physiologist Louise O'Brien, Ph.D., M.S., and psychiatrist Juan Lopez, M.D., will provide focused training in perinatal sleep and neuroendocrinology, respectively. The proposal is also bolstered by a tailored consultant team. Research. The goal of this application is to understand the contribution of sleep-disordered breathing (SDB) to one of the most common and debilitating adverse pregnancy outcomes, perinatal depression. It is our hypothesis that positive airway pressure (PAP) treatment of SDB in pregnant women with comorbid depression will result in significant reductions in depressive symptoms and improved neuroendocrine functioning. This proposal will leverage our unique expertise with PAP for SDB in pregnancy and adverse pregnancy outcomes, including perinatal depression. The rationale is that a better understanding of the role of SDB and the impact of PAP treatment on perinatal depression will allow for development of targeted and critically-timed interventions which may have long-term benefits for both women and their offspring. We plan to test our hypothesis by randomly assigning 50 women with SDB to receive either positive airway pressure treatment (PAP group) or treatment as usual in obstetrics (non-PAP group). The following specific aims will be tested: AIM 1: Determine the impact of PAP treatment on prenatal depressive symptoms in pregnant women with SDB and depression. AIM 2: Identify the contribution of PAP treatment on the HPA axis in pregnant women with SDB and depression. An exploratory aim is to assess associations between PAP treatment and adverse pregnancy and neonatal outcomes in women with depression and SDB. With respect to expected outcomes, the proposed work will demonstrate that SDB during pregnancy plays a role in perinatal depression, and that treatment of SDB during pregnancy will ameliorate depressive symptoms and HPA axis functioning, and improve pregnancy and neonatal outcomes. Such findings are expected to have an important positive impact, because they will further our understanding of the role of SDB in adverse pregnancy outcomes and reduce the burden of the most common and debilitating adverse outcomes experienced by pregnant women. This will have long term health benefits for both women and their offspring. Summary. The proposed K23 will provide key additional training for a promising early investigator to become a clinical researcher in perinatal sleep medicine. The project will also address important, testable questions about the relationships between a common sleep disorder and the debilitating adverse pregnancy outcome of perinatal depression, a major public health concern.

 描述（由申请人提供）：这项以患者为导向的研究职业发展奖提出了一个量身定制的指导、重点研究、教学和课程作业的计划，为候选人提供独立作为研究者所必需的睡眠医学和围产期神经内分泌功能方面的培训。候选人在临床研究方面的背景和基础使她为获得该奖项做好了准备。她在阿拉巴马大学获得了临床心理学博士学位。对睡眠和情绪的兴趣促使她在密歇根大学攻读博士后，在那里她开始在行为睡眠医学和围产期心理健康领域发展自己的研究领域，最近被任命为该大学的教员。她的目标是在密歇根大学精神病学系接受额外的睡眠医学和围产期神经内分泌学培训，该候选人确定了实现完全独立的研究人员所需的两个关键培训目标：（1）睡眠生理学经验（包括评估）。和治疗妊娠期睡眠呼吸障碍）和（2）妊娠期神经内分泌学 拟议的项目将在密歇根大学精神病学系和睡眠障碍中心内进行。密歇根大学是美国第五大妇产科研究型大学，提供广泛的资源和丰富的研究环境，候选人将可以使用睡眠障碍中心内的大型、经过认可的睡眠实验室。妇女心理健康和婴儿计划内完善的围产期招募基础设施（与产科合作），以及由 CTSA 资助的密歇根临床和健康研究所提供的资源 拟议的主要导师 Ronald Chervin 医学博士，硕士，是一位资金雄厚、高产的睡眠呼吸障碍专家，在睡眠医学领域拥有 20 多年的经验，并长期指导 K 获奖者和两名精心挑选的初级教师。共同导师生理学家 Louise O'Brien 博士、硕士和精神病学家 Juan Lopez 医学博士将分别提供围产期睡眠和神经内分泌学方面的重点培训。该应用程序的目标是了解睡眠呼吸障碍 (SDB) 对最常见和最令人衰弱的不良妊娠结局之一——围产期抑郁症的影响。我们的假设是气道正压通气 (PAP)。对患有抑郁症的孕妇进行 SDB 治疗将显着减轻抑郁症状并改善神经内分泌功能。该提案将利用我们在妊娠期 SDB 方面的独特专业知识和不良妊娠结局（包括围产期抑郁症）。了解 SDB 的作用以及 PAP 治疗对围产期抑郁症的影响将有助于制定有针对性的、关键时机的干预措施，这可能对妇女及其后代产生长期益处。我们计划随机检验我们的假设。分配 50 名患有 SDB 的女性接受气道正压治疗（PAP 组）或产科常规治疗（非 PAP 组）。将测试以下具体目标： 目标 1：确定 PAP 治疗对产前抑郁症状的影响。目的 2：确定 PAP 治疗对患有 SDB 和抑郁症孕妇的 HPA 轴的影响 探索性目的是评估 PAP 治疗与抑郁症之间的关联。患有抑郁症和 SDB 的妇女的不良妊娠和新生儿结局就预期结果而言，拟议的工作将证明妊娠期间的 SDB 在围产期抑郁症中发挥作用，并且妊娠期间的 SDB 治疗将改善抑郁症状和 HPA 轴功能，这些发现预计将产生重要的积极影响，因为它们将进一步了解 SDB 在不良妊娠结局中的作用，并减轻孕妇经历的最常见和使人衰弱的不良结局的负担。这将拟议的 K23 将为有前途的早期研究者提供关键的额外培训，使其成为围产期睡眠医学的临床研究人员。一种常见的睡眠障碍和围产期抑郁症导致的令人衰弱的不良妊娠结局，这是一个主要的公共卫生问题。