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（由适用提供）：这项受到指导的面向患者的研究职业发展奖提案提案一项量身定制的心态，重点研究，教学和课程，以为候选人提供睡眠医学和围产期神经内分泌功能的培训，使其成为独立性作为研究者所必需的。候选人。候选人在临床研究中的背景和基础使她为这个奖项付出了良好的努力。她完成了博士学位阿拉巴马大学的临床心理学博士学位，在那里她接受了植根于科学家培训模型的培训。对睡眠和情绪的新兴兴趣使她在密歇根大学获得了博士后奖学金，在那里她开始在行为睡眠医学和围产期心理健康方面发展一个利基市场。她最近被任命为密歇根大学精神病学系。她的目标是接受睡眠医学和围产期神经内分泌学方面的额外培训。候选人已经确定了作为研究人员充分独立所必需的两个关键培训目标：（1）睡眠生理学的经验（包括怀孕期间的睡眠呼吸呼吸评估和治疗）和（2）怀孕中神经内分泌学。环境。拟议的项目将在密歇根大学精神病学系和睡眠障碍中心举行。这两个部门都有与妇产部密切合作的悠久历史。密歇根大学是美国第五大研究大学，提供了广泛的资源和丰富的研究环境。候选人将可以进入睡眠障碍中心内的大型睡眠实验室，这是妇女精神健康和婴儿计划中良好的围产期招募基础设施（与妇产科协作），以及CTSA资助的密歇根州临床和健康研究所提供的资源。拟议中的主要导师Ronald Chervin，M.D。，M.S。是一位资金丰富，高产的睡眠呼吸专家，在睡眠医学方面拥有20多年的经验，并且具有悠久的精神上的K Adaginees和初级教师的历史。两位精心挑选的联合官员，生理学家路易丝·奥布莱恩（Louise O'Brien）博士，M.S。和精神科医生Juan Lopez，M.D。将分别提供有关围产期睡眠和神经内分泌学的重点培训。该提案也由量身定制的顾问团队加强。研究。该应用的目的是了解睡眠有序的呼吸（SDB）对最常见且令人衰弱的不良怀孕结局之一，即围产期抑郁症的贡献。我们的假设是，在合并症抑郁症的孕妇中，气道压力（PAP）治疗SDB的阳性会导致抑郁症状显着降低并改善神经内分泌功能。该提案将利用我们在怀孕和不良怀孕结果（包括围产期抑郁症）中使用SDB的PAP的独特专业知识。理由是，更好地了解SDB的作用以及PAP治疗对围产期抑郁症的影响将允许发展有针对性的和批判性的干预措施，这些干预措施可能对妇女及其后代有长期利益。我们计划通过随机分配的50名患有SDB的女性来测试我们的假设，以接受阳性气道压力治疗（PAP组）或妇产科治疗（非PAP组）。将测试以下具体目标：目标1：确定子宫颈瘤治疗对SDB和抑郁症孕妇产前抑郁症状的影响。目标2：确定SDB和抑郁症孕妇对HPA轴的PAP治疗的贡献。探索性的目的是评估抑郁症和SDB女性的子宫颈疾病治疗与不良妊娠与新生儿结局之间的关联。关于预期的结果，拟议的工作将证明怀孕期间的SDB在围产期抑郁症中起作用，而怀孕期间SDB的治疗将改善抑郁症状和HPA轴功能，并改善妊娠和新生儿效果。预计此类发现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，并减少孕妇经历的最常见和令人衰弱的不良后果。这将为妇女及其后代带来长期的健康益处。概括。拟议的K23将为承诺的早期研究人员提供关键的额外培训，以成为围产期睡眠医学的临床研究人员。该项目还将解决有关共同睡眠障碍与围产期抑郁症的不良怀孕后果之间关系的重要，可检验的问题，这是一个主要的公共卫生问题。