Prospective Assessment of The Etiology of Insomnia in Middle Aged & Elder Adults

中年失眠病因的前瞻性评估

• 批准号: 8438273
• 负责人: Michael Lloyd Perlis
• 金额: $ 50.26万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8438273
• 关键词: Accounting; Acute; Address; Adult; Age; Aging; Anxiety Disorders; Architecture; Area; Attention; Back; Behavioral; Belief; Biological; Biological Assay; Biological Markers; Blood Coagulation Factor VII; Cardiovascular Diseases; Chronic; Chronic Insomnia; Circadian Rhythms; Clinical; Clinical Management; Clinical assessments; Cognitive; Collection; Data; Development; Disease remission; Elderly; Electroencephalography; Epidemiologic Studies; Etiology; Event; Exhibits; Extroversion; Fatigue; Frequencies; Health; Health Status; Hydrocortisone; Hygiene; Hypertension; Impaired cognition; Incidence; Individual; Intake; International; Internet; Investigation; Laboratory Study; Left; Life; Life Stress; Literature; Longevity; Longitudinal Studies; Maintenance; Major Depressive Disorder; Measures; Mediating; Mediator of activation protein; Medical; Melatonin; Mental Depression; Mental Health; Monitor; Napping; Natural History; Nature; Neurotic Disorders; Outcome; Parents; Patient Self-Report; Patients; Pattern; Phase; Philadelphia; Polysomnography; Population; Prevalence; Psychological Factors; Public Health; Quality of life; Recovery; Recruitment Activity; Recurrence; Regimen; Relapse; Relative (related person); Reporting; Resolution; Risk; Risk Factors; Sampling; Science; Severities; Sleep; Sleeplessness; Stimulus; Stress; Substance abuse problem; Surveys; Symptoms; Testing; Time; United States National Institutes of Health; Urine; Vulnerable Populations; Waxes; Weight; Work; acute stress; base; blood glucose regulation; cohort; conditioning; coping; disturbance in affect; experience; health care service utilization; high risk; mental development; middle age; mortality; prospective; psychologic; skills; symposium; theories; trend; urinary

DESCRIPTION (provided by applicant): Insomnia is common among older adults with sleep continuity disturbance being nearly three times more common in the elderly than in the overall population. This increased prevalence is of significant clinical concern as insomnia represents, in the population at large, a risk factor for new onset and recurrent psychiatric and medical illness. For older adults, the increased prevalence of insomnia may serve to make them more vulnerable to the illnesses that occur with advancing age. Despite this, very little is known about the natural history of insomnia and still less is known about the factors that appear to uniquely predispose, precipitate, and/or perpetuate insomnia in the elderly. The lack of work within this area has left the field without incidence data and temporal trends regarding new onset acute and chronic insomnia in general and in specific in older adults. Furthermore, there is no empirically based assessment of the factors that are thought to moderate/mediate maintenance of good sleep, the occurrence of (and remission/recovery from) acute insomnia, and the transition from acute to chronic insomnia. In the absence of such data, it has been hypothesized that acute insomnia occurs as an interaction between predispositional factors and acute stress (perceived or real threat) and that chronic insomnia occurs as a result of cognitive, behavioral, and conditioning factors. None of these sets of factors have ever been assessed prospectively, assessed for their relative contribution to clinical course, or assessed for how they vary with age. Accordingly, we propose to conduct a large scale, longitudinal, internet-based study across three age cohorts (middle aged [35 to 55 years], Young Elders [55 to 75 years], and Older Elders [75 years and older]). Each age cohort (comprised of 500 good sleepers and 500 individuals with acute insomnia) will be recruited via an international polling agency and surveyed on seven occasions (original Zogby survey, Intake, one, three, six, nine and 12 months) regarding life events, sleep continuity, health, mental health status, and other factors that have been theorized to mediate clinical course. In addition to the longitudinal self-report assessment, a sample of 90 subjects (over three years) with acute insomnia will be recruited from the parent sample (local to the Philadelphia region) to take part in two lab-based studies (once when the insomnia is acute and then again when the subject exhibits remission or chronic insomnia). The lab assessment will include two nights of polysomnography, the collection of urine samples at each void (to assess cortisol and melatonin levels), and the administration of an attention bias test regimen. The primary aims of the study are to: 1) profile the incidence rates of acute and chronic insomnia across the three age cohorts; 2) assess which of the theory driven factors best accounts for (alone and in combination) the various clinical course scenarios; and 3) determine if lab based biological measures distinguish between the various clinical course scenarios

描述（由申请人提供）：失眠在老年人中很常见，睡眠连续性障碍在老年人中的发生率几乎是总人口的三倍。这种患病率的增加引起了临床上的重大关注，因为在广大人群中，失眠是新发和复发性精神疾病和内科疾病的危险因素。对于老年人来说，失眠患病率的增加可能使他们更容易患上随着年龄增长而发生的疾病。尽管如此，人们对此知之甚少 人们对失眠的自然史了解甚少，但对于老年人失眠的独特诱发、促成和/或持续的因素则知之甚少。由于该领域工作的缺乏，该领域没有关于新发急性和慢性失眠的发病率数据和时间趋势，特别是在老年人中。此外，对于被认为调节/介导良好睡眠的维持、急性失眠的发生（和缓解/恢复）以及从急性失眠到慢性失眠的转变的因素，没有基于经验的评估。在缺乏此类数据的情况下，有人假设急性失眠是由于倾向因素和急性压力（感知或真实威胁）之间的相互作用而发生的，而慢性失眠是由于认知、行为和条件因素而发生的。这些因素中的任何一个都没有被前瞻性地评估过，评估它们对临床过程的相对贡献，或评估它们如何随年龄变化。因此，我们建议对三个年龄组（中年人[35至55岁]、年轻长者[55至75岁]和老年长者[75岁及以上]）进行大规模、纵向、基于互联网的研究。每个年龄组（由 500 名睡眠良好者和 500 名急性失眠者组成）将通过国际民意调查机构招募，并针对生活事件进行七次调查（原始 Zogby 调查，摄入量、1、3、6、9 和 12 个月） 、睡眠连续性、健康、心理健康状况以及其他已被理论化的可调节临床过程的因素。除了纵向自我报告评估外，还将从父母样本（费城地区本地）中招募 90 名患有急性失眠症的受试者（超过三年），参加两项基于实验室的研究（一次当失眠是急性的，然后当受试者表现出缓解或慢性失眠时再次失眠）。实验室评估将包括两个晚上的多导睡眠图、每次排尿时收集尿液样本（以评估皮质醇和褪黑激素水平）以及进行注意力偏差测试方案​​。该研究的主要目的是：1）分析三个年龄组中急性和慢性失眠的发病率； 2）评估哪种理论驱动因素最能解释（单独或组合）各种临床过程场景； 3) 确定基于实验室的生物测量是否区分各种临床过程场景