The Impact of Insomnia on Pain, Physical Function, and Inflammation in HIV

失眠对 HIV 患者疼痛、身体功能和炎症的影响

• 批准号: 10225460
• 负责人: Burel R. Goodin
• 金额: $ 65.02万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10225460
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adult; Agreement; Alabama; Anti-Inflammatory Agents; Attention; Biological; Biological Markers; Blood; Centers for Disease Control and Prevention (U.S.); Circadian Dysregulation; DSM-V; Data; Development; Diagnostic; Etiology; Funding; Genomics; Guidelines; HIV; Health; Home; Hyperalgesia; Individual; Inflammation; Inflammation Mediators; Inflammatory; Inflammatory Response; Interleukin-6; Interview; Laboratories; Life; Link; Literature; Maps; Measures; Mediator of activation protein; Methods; Mission; Neurobiology; Pain; Pain Threshold; Participant; Patient Self-Report; Persons; Physical Function; Physiological; Pilot Projects; Polysomnography; Population; Prevalence; Procedures; Process; Public Health; Quality of life; Questionnaires; Research; Research Design; Research Priority; Resources; Risk Factors; Sampling; Severities; Sleep; Sleep Deprivation; Sleep Disorders; Sleep disturbances; Sleeplessness; Standardization; Stimulus; Structure; TNF gene; Testing; Time; United States National Institutes of Health; Universities; Variant; Vulnerable Populations; actigraphy; chronic pain; comorbidity; comparison group; design; diaries; experience; falls; inflammatory marker; innovation; monitoring device; pain sensitivity; pain symptom; physically handicapped; poor sleep; sleep quality; stressor; systemic inflammatory response; therapeutic target; trend

Project Summary/Abstract Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or both, despite adequate opportunity for sleep attainment. As a result, people with insomnia may get too little sleep and/or have poor sleep quality. Insomnia is a common and debilitating sleep disorder in persons living with HIV (PLWH), with prevalence estimates ranging from 30-73%. Insomnia is increasingly viewed as a risk factor for the onset and/or worsening of pain symptoms and physical functioning deficits. Insomnia has been found to promote enhanced pain sensitivity (also known as hyperalgesia), which is critical to the etiology of pain in everyday life. This is particularly relevant for PLWH because recent evidence attests to the fact that pain symptoms are quite prevalent in the daily lives of PLWH. Whether insomnia is a risk factor for the experience of pain and poor physical functioning in PLWH is a topic that has received minimal attention to date; therefore, additional research is needed. Inflammatory processes represent an important biologic mechanism linking insomnia to pain and physical function. Insomnia promotes systemic inflammation as well as inflammatory reactivity to physical stressors like pain. Research conducted with non-HIV samples has shown that inflammation can substantially increase sensitivity to painful stimuli in the laboratory setting, as well as exacerbate pain symptoms in everyday life and physical disability. Taken together, insomnia may drive pain and physical function in PLWH through the proliferation of inflammatory mediators. There is currently a need to elucidate mechanisms and mediators of sleep disorders in PLWH, and the consequences and influences of these disturbances on other HIV-related comorbidities. Accordingly, the overall objective of this proposal is to investigate the impact of insomnia on pain, physical function, and inflammation in PLWH. We will accomplish our overall objective by addressing the following specific aims: 1) determine whether insomnia promotes increased experimental pain sensitivity and exaggerated inflammatory reactivity to painful stimuli in PLWH, and 2) determine if fluctuations in insomnia burden over time drive inflammation and pain in everyday life, and physical functioning among PLWH. These aims will be addressed using study methods developed and rigorously refined by our research team, and which have previously yielded promising preliminary results suggesting that insomnia may indeed promote pain and inflammation in PLWH. This approach is innovative because the impact of insomnia on pain and pain-related inflammatory processes has never before been directly examined in PLWH. Furthermore, the incorporation of objective as well as subjective measures of sleep and physical function, experimental pain testing, and a wide array of pro- and anti-inflammatory biomarkers also contributes to the innovation of this proposal. The proposed research will be significant because, if our hypotheses are confirmed, we will identify: 1) insomnia as a major driver of pain and physical functioning in the laboratory and in everyday life among PLWH, and 2) inflammation as an important insomnia-related mediator of pain in PLWH.

项目概要/摘要 失眠是一种睡眠障碍，其特征是即使充足的睡眠也难以入睡、保持睡眠或两者兼而有之。 获得睡眠的机会。因此，失眠的人可能会睡眠过少和/或睡眠质量不佳 质量。失眠是艾滋病毒感染者 (PLWH) 中一种常见且令人衰弱的睡眠障碍，患病率很高 估计范围为 30-73%。失眠越来越被视为失眠发作和/或恶化的危险因素 疼痛症状和身体机能缺陷。研究发现失眠会加剧疼痛 敏感性（也称为痛觉过敏），对于日常生活中疼痛的病因至关重要。这一点特别 与 PLWH 相关，因为最近的证据证明疼痛症状在 感染者的日常生活。失眠是否是疼痛和身体功能不良的危险因素 艾滋病毒感染者的问题是迄今为止受到最少关注的话题；因此，需要进行更多研究。 炎症过程代表了将失眠与疼痛和身体联系起来的重要生物机制。 功能。失眠会促进全身炎症以及对身体压力源的炎症反应，例如 疼痛。对非艾滋病毒样本进行的研究表明，炎症会大幅增加 在实验室环境中对疼痛刺激敏感，以及在日常生活中加剧疼痛症状 身体残疾。总而言之，失眠可能通过以下方式导致 PLWH 的疼痛和身体功能下降： 炎症介质的增殖。目前需要阐明其机制和中介因素 艾滋病病毒感染者的睡眠障碍，以及这些障碍对其他艾滋病毒相关疾病的后果和影响 合并症。因此，该提案的总体目标是调查失眠对疼痛的影响， PLWH 的身体功能和炎症。我们将通过解决以下问题来实现我们的总体目标 以下具体目标：1）确定失眠是否会促进实验性疼痛敏感性的增加； PLWH 对疼痛刺激的过度炎症反应，以及 2) 确定失眠是否波动 随着时间的推移，负担会导致感染者日常生活中的炎症和疼痛以及身体机能的下降。这些 将使用我们的研究团队开发和严格完善的研究方法来实现目标，并且 此前已经取得了有希望的初步结果，表明失眠确实可能会加剧疼痛和 PLWH 中的炎症。这种方法是创新的，因为失眠对疼痛的影响以及与疼痛相关的 以前从未直接检查过感染者的炎症过程。此外，纳入 睡眠和身体功能的客观和主观测量、实验性疼痛测试以及广泛的 一系列促炎和抗炎生物标志物也有助于该提案的创新。拟议的 研究将具有重要意义，因为如果我们的假设得到证实，我们将确定：1）失眠是一个主要的 实验室和感染者日常生活中疼痛和身体机能的驱动因素，2) 炎症 作为 PLWH 中与失眠相关的疼痛的重要介质。