Sleep Disturbance in Rheumatoid Arthritis: Phenotypes, Causes, and Impact

类风湿性关节炎的睡眠障碍：表型、原因和影响

• 批准号: 9756144
• 负责人: Patricia P Katz
• 金额: $ 66.51万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9756144
• 关键词: Address; Affect; Arthritis; Attention; Biological; Biological Markers; Blood; Circadian Dysregulation; Circadian Rhythms; Classification; Clinical; Cognitive; Collaborations; Collection; Comorbidity; Data; Development; Disease; Enrollment; Evaluation; Excessive Daytime Sleepiness; Fatigue; Glucocorticoids; Goals; Health; Health Status; High Prevalence; Home environment; Hormonal; Hour; Hydrocortisone; Immune; Immunology; Impairment; Individual; Inflammation; Inflammatory; Interleukin-6; Intervention; Knowledge; Lead; Link; Longitudinal Studies; Measures; Mediator of activation protein; Mental Depression; Methods; Modeling; Monitor; Neurosecretory Systems; Outcome; Output; Pain; Pain Threshold; Pathway interactions; Patient Self-Report; Patients; Pattern; Persons; Pharmaceutical Preparations; Phenotype; Physical Function; Physical activity; Polysomnography; Population; Prevalence; Prevention; Process; Proteins; Psychoneuroimmunology; Quality of life; Questionnaires; Regulation; Reporting; Research; Research Personnel; Rest; Rheumatoid Arthritis; Rheumatology; Risk; Risk Factors; Role; Salivary; Sampling; Severities; Sleep; Sleep Disorders; Sleep disturbances; Statistical Methods; Symptoms; Telephone; Testing; Therapeutic; Variant; actigraphy; analytical method; arthritic pain; arthritis therapy; base; circadian; cognitive function; cohort; depressive symptoms; design; diaries; dosage; evidence base; falls; follow-up; immune function; improved; inflammatory marker; innovation; insight; new technology; novel; novel therapeutic intervention; prospective; response; screening; sleep quality

Project Summary/Abstract Self-reported sleep problems are common in rheumatoid arthritis (RA), but objectively-measured data on sleep are lacking. Our preliminary data provide evidence of frequent self-reported sleep problems, existence of objectively-identified sleep disturbances, and the association of those sleep disturbances with poor RA-specific health outcomes. The proposed project will address the significant knowledge gaps surrounding sleep disturbances in RA. Project aims are to: (1) identify risk factors associated with sleep disturbance and changes in sleep disturbance in individuals with RA; (2) identify the short-term and longer-term longitudinal effects of sleep disturbance and changes in sleep disturbances on health outcomes in RA; and (3) examine a biological pathway unique to RA to explain the high prevalence of sleep disturbance in RA and associations with RA outcomes. No previous studies have attempted to link the disruptions in inflammatory biomarkers and cortisol, and the concomitant peaking of RA symptoms, with sleep disturbance or with disruption of circadian rest- activity patterns. 150 individuals with RA will be enrolled and followed over 24 months. Baseline, 6- and 12- month assessments will consist of 7-nights of actigraphy monitoring to measure sleep and circadian rest- activity patterns; completion of sleep and symptom diaries; questionnaires to assess disease activity, pain, fatigue, physical activity, and symptoms of depression; blood draws for inflammatory markers; and salivary diurnal cortisol collection. Screening for other primary sleep disorders will be conducted at baseline. Follow-ups 18 and 24 months after baseline will continue monitoring sleep and outcomes with 7 nights of sleep monitoring by actigraphy and completion of sleep/symptom diaries and questionnaires. Bi-weekly telephone check-ins will be conducted to monitor use, dosage, and timing of glucocorticoids (GCs) and other medications. Innovative components of the proposed project include objective measurements of sleep, detailed examination of the role of GCs in sleep disturbance in RA, examination of the roles of inflammatory and hormonal biomarkers, and the extended longitudinal assessments, which will permit examination of the potential reciprocal effects of sleep disturbance, inflammation, circadian variation in cortisol, and RA symptoms and disease activity. The study team includes a unique collaboration of investigators with expertise in rheumatology, sleep, immunology, psychoneuroimmunology, and statistical methods. Data will yield insights into predictors and mechanistic precursors of sleep disturbance, provide information regarding the impact of sleep disturbance on RA health outcomes, and provide preliminary evidence for potential interventions. Understanding sleep disturbances in RA is important because assessments of RA disease activity, as well as decisions on the use, timing and evaluation of response to RA therapy, may be impacted by concurrent sleep problems. Better understanding of sleep disturbances in RA may lay groundwork for design and conduct of studies to improve therapeutic strategies, which will ultimately improve health and quality of life of persons with RA.

项目摘要/摘要 自我报告的睡眠问题在类风湿关节炎（RA）中很常见，但客观测量的数据 缺乏睡眠。我们的初步数据提供了经常自我报告的睡眠问题的证据，存在 客观识别的睡眠障碍以及这些睡眠障碍与RA特异性差的障碍的关联 健康结果。拟议的项目将解决围绕睡眠的重大知识差距 RA的干扰。项目的目的是：（1）确定与睡眠障碍和变化相关的危险因素 RA患者的睡眠障碍； （2）确定短期和长期纵向影响 睡眠障碍和RA健康状况的睡眠障碍变化； （3）检查生物学 RA独有的途径可以解释RA中睡眠障碍的高流行率，并与RA的关联 结果。以前没有研究试图将炎性生物标志物和皮质醇的破坏联系起来， RA症状的伴随峰值，睡眠障碍或昼夜节律中断 - 活动模式。 150名患有RA的人将被招募，并在24个月内遵循。基线，6和12-- 月份评估将包括7晚的行为监测，以衡量睡眠和昼夜节律 - 活动模式；睡眠和症状日记完成；评估疾病活动，疼痛， 疲劳，体育锻炼和抑郁症状；血液吸收炎症标记；和唾液 昼夜皮质醇系列。将在基线进行其他原发性睡眠障碍的筛查。后续行动 基线后的18和24个月将继续监视睡眠和结局，并进行7晚睡眠监测 通过艺术学和睡眠/症状日记和问卷的完成。每两周打电话将 进行监测糖皮质激素（GC）和其他药物的使用，剂量和时间。创新的 拟议项目的组成部分包括对睡眠的客观测量，对角色的详细检查 GC在RA中的睡眠障碍中，检查炎症和激素生物标志物的作用以及 扩展的纵向评估将允许检查睡眠的潜在相互影响 干扰，炎症，皮质醇的昼夜节律变化以及RA症状和疾病活动。研究 团队包括研究人员的独特合作，具有风湿病，睡眠，免疫学专业知识， PsychOneuromumumumunology和统计方法。数据将产生对预测因子和机理的见解 睡眠障碍前体，提供有关睡眠障碍对RA健康的影响的信息 结果，并为潜在干预提供初步证据。了解睡眠障碍 RA很重要，因为评估RA疾病活动以及对使用，时机和 评估对RA治疗的反应，可能会受到同时睡眠问题的影响。更好地理解 RA中的睡眠障碍可能为设计和进行研究以改善治疗性而奠定基础 策略，最终将改善RA患者的健康和生活质量。