Sleep deficiency and opioid use/misuse in adolescents following surgery

青少年术后睡眠不足和阿片类药物使用/滥用

• 批准号: 10734732
• 负责人: Cornelius Botha Groenewald
• 金额: $ 64.14万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-10 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10734732
• 关键词: Acute; Acute pain management; Address; Adolescent; Adolescent Development; Affect; Athletic Injuries; Behavior; Behavior Therapy; Behavioral; Behavioral Mechanisms; Clinical Trials; Data; Development; Dose; Ecological momentary assessment; Electronics; Exposure to; Family; Future; Intervention; Knowledge; Measures; Mediating; Mediation; Medical; Mental Depression; Methodology; Methods; Modernization; Monitor; Moods; Observational Study; Operative Surgical Procedures; Opioid; Orthopedic Surgery; Overdose; Pain; Pain intensity; Pain management; Participant; Pathway interactions; Patient Self-Report; Perioperative; Pharmaceutical Preparations; Pilot Projects; Prevention; Process; Psychological Factors; Public Health; Recording of previous events; Reporting; Research; Risk; Risk Factors; Sleep; Sleep Deprivation; Sleep Disorders; Surgical Injuries; Surveys; Technology; Testing; Time; United States; Youth; actigraphy; adolescent patient; critical period; follow up assessment; innovation; machine learning algorithm; modifiable risk; multimodality; novel; opioid epidemic; opioid misuse; opioid use; opioid use disorder; peer; poor sleep; predictive modeling; prescription opioid; prescription opioid misuse; prospective; psychologic; psychological symptom; psychosocial; public health relevance; response; sleep quality; substance use; therapeutic target

PROJECT SUMMARY Prescription opioid misuse is a significant burden on adolescent public health in the United States. Opioid misuse often starts with prescribed opioids, with surgery representing a key pathway by which adolescents are first prescribed opioids for the management of acute pain. Yet, little is known about the critical period following surgery during which adolescents initiate prescription opioid misuse or the modifiable behavioral mechanisms contributing to this process. These are critical gaps in our knowledge impeding our ability to identify adolescents at increased risk for opioid misuse and to develop interventions aimed at reducing prescription opioid misuse. Sleep deficiency (including sleep deprivation, noncircadian sleep, sleep disorders, and poor sleep quality) is an important proximal risk factor for prescription opioid misuse. Sleep is often disturbed during the perioperative period, a time when many adolescents are exposed to their first opioid prescription. Indeed, in our own preliminary study, we found that sleep deficiency present both before surgery and during the immediate postsurgical period was associated with increased opioid use. However, this pilot study did not allow us to characterize aspects of sleep most strongly related to opioid use and did not allow us to evaluate mechanisms, such as pain and psychological factors, underlying the sleep – opioid use relationship. Furthermore, data are urgently needed to determine how sleep deficiency prospectively predicts the development of opioid misuse behaviors in the context of other putative factors, such as a history of substance use, pain intensity, psychosocial (e.g., depression), peer, and family factors. Given that sleep deficiency is modifiable, it is a critical focus of research aimed at reducing the development of adolescent opioid misuse behaviors. Therefore, this project aims to 1) test the direct and mediation pathways of sleep deficiency, pain, psychological factors, and opioid use following sports-injury surgery, and 2) develop and validate a multivariable prediction model to identify adolescents at increased risk of prescription opioid misuse over the 24 months following surgery. To address these aims, we propose a prospective, observational study of N= 400 adolescents (10-19 years) who receive their first ever opioid following sports injury surgery. Presurgery, participants will undergo comprehensive multimodal sleep assessments (surveys and actigraphy monitoring) to measure sleep deficiency. Participants will also report on previous substance use, pain intensity, psychosocial, peer, and family factors. Adolescents will then be followed over the first 14 days after surgery using ecological momentary assessment to capture real-time daily data on sleep, pain, psychological factors, and opioid use. We will use an innovative electronic medication monitoring methodology to accurately measure opioid use (total number of doses and duration) following surgery. Follow-up assessments at 3-months, 6-months, 12- months, and 24-months will track opioid misuse developing over time. We will apply modern machine learning algorithms to develop and validate models predicting adolescent prescription opioid misuse.

项目概要 处方阿片类药物滥用对美国青少年公共卫生造成重大负担。 滥用通常从处方阿片类药物开始，而手术是青少年滥用阿片类药物的一个关键途径。 首次使用阿片类药物来治疗急性疼痛，但人们对接下来的关键时期知之甚少。 青少年开始滥用处方阿片类药物或可改变的行为机制的手术 这些是我们知识中的关键差距，阻碍了我们识别的能力。 青少年滥用阿片类药物的风险增加，并制定旨在减少处方的干预措施 阿片类药物滥用。睡眠不足（包括睡眠剥夺、非昼夜节律睡眠、睡眠障碍和睡眠质量差）。 睡眠质量）是处方阿片类药物滥用的一个重要近端风险因素。 事实上，在围手术期，许多青少年第一次接触阿片类药物。 在我们自己的初步研究中，我们发现手术前和手术期间都存在睡眠不足的情况 术后即刻与阿片类药物使用增加相关，但该试点研究并未发现。 让我们能够描述与阿片类药物使用最密切相关的睡眠方面，但不允许我们评估 睡眠与阿片类药物使用关系的机制，例如疼痛和心理因素。 此外，迫切需要数据来确定睡眠不足如何前瞻性地预测 在其他推定因素（例如物质史）的背景下出现阿片类药物滥用行为 考虑到睡眠不足是影响因素，包括使用情况、疼痛强度、社会心理（例如抑郁）、同伴和家庭因素。 它是可修改的，是旨在减少青少年阿片类药物滥用的研究的一个关键焦点 因此，该项目旨在 1）测试睡眠不足、疼痛、 心理因素和运动损伤手术后阿片类药物的使用，以及 2) 开发并验证 多变量预测模型可识别处方阿片类药物滥用风险增加的青少年 手术后 24 个月，为了实现这些目标，我们提出了一项 N= 400 人的前瞻性观察性研究。 运动损伤手术后首次接受阿片类药物的青少年（10-19 岁）， 参与者将接受全面的多模式睡眠评估（调查和体动记录监测），以 参与者还将报告以前的药物使用情况、疼痛强度、心理社会状况、 然后将在手术后的前 14 天内使用生态系统对青少年进行跟踪。 瞬时评估，以捕获有关睡眠、疼痛、心理因素和阿片类药物使用的实时每日数据。 我们将使用创新的电子药物监测方法来准确测量阿片类药物的使用情况 （总剂量和持续时间）术后 3 个月、6 个月、12 个月的随访评估。 几个月和 24 个月将跟踪阿片类药物滥用随时间的发展。我们将应用现代机器学习。 开发和验证预测青少年处方阿片类药物滥用的模型的算法。