Impact of Behavioral Treatment of Insomnia on Nighttime Urine Production

失眠行为治疗对夜间尿量的影响

• 批准号: 9788256
• 负责人: Shachi Tyagi
• 金额: $ 19.56万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9788256
• 关键词: Adult; Affect; Age; Argipressin; Atrial Natriuretic Factor; Behavior; Behavior Therapy; Behavioral; Biological; Bladder; Cessation of life; Circadian Rhythms; Communities; Comorbidity; Data; Development; Diabetes Mellitus; Diurnal Rhythm; Edema; Elderly; Electrolytes; Etiology; Excretory function; Fluid overload; Fracture; Functional disorder; Goals; Heart failure; Hormone secretion; Hormones; Intervention; Investigation; Knowledge; Measures; Mediating; Mental Depression; Middle Insomnia; Modification; Nocturia; Nursing Homes; Participant; Pathologic; Pattern; Pharmacology; Pharmacotherapy; Physiological; Play; Polyuria; Population; Production; Protocols documentation; Quality of life; Randomized; Renin-Angiotensin-Aldosterone System; Reporting; Research; Role; Severities; Sleep; Sleep Deprivation; Sleep Stages; Sleep disturbances; Sleeplessness; Slow-Wave Sleep; Sodium Chloride; Testing; Training; Urine; Water; Wrist; actigraphy; aged; circadian; cost; diaries; effective therapy; fall risk; hormone regulation; improved; indexing; innovation; insight; lower urinary tract symptoms; multimodality; post intervention; prospective; recruit; sleep quality; young adult

PROJECT SUMMARY Prevalent, morbid, and costly ($61 billion/year in 2012), nocturia is a major problem, especially for older adults. It increases the risk of falls, fractures, depression, nursing home placement, and death. Yet management of nocturia remains inadequate. Most behavior and pharmacotherapies for nocturia focus on bladder-related etiologies, and it’s most prevalent attribute nocturnal polyuria (NP), or increased urine production during sleep remains poorly understood and inadequately treated with little advancement over the last 50 years. Disruption of diurnal excretory pattern, with higher nighttime urine production is common in older adults. While studies in young adults show that sleep plays a critical role in regulating nighttime urine production, among older adults the role of poor sleep in NP is under-investigated. Urine production follows a circadian pattern in which transition from wake to sleep is followed by a pronounced decrease in excretion of water, electrolytes and other osmotically active substances. Studies in young population have established that physiological urine production follows a circadian rhythm, which is regulated by diurnal variation in secretion of hormones controlling water and salt excretion such as arginine vasopressin, renin-angiotensin-aldosterone system, and atrial natriuretic peptide. Sleep deprivation blunts nocturnal surge of these hormones and consequently alter water and salt excretion thereby increase nighttime urine volume leading to NP. Recent evidence suggests that poor sleep quality, frequent sleep interruptions especially in the first part of the night and shorter duration of first uninterrupted sleep period are associated with NP but its pathophysiology is not fully understood. Additionally, among older adults with poor sleep, we have shown that a behavioral intervention directed solely towards sleep (BBTI- brief behavioral treatment of insomnia an efficacious multimodal behavioral treatment for insomnia) not only improves sleep, but also nocturia. Hence, we postulate that sleep interruptions in the first part of the sleep impacts the hormonal regulation of nighttime urine production causing NP. In addition, we postulate that interventions to prolong the first uninterrupted sleep period will decrease NP and hence nocturia. The, aims of the present proposal are to: 1) examine the impact of BBTI on duration of the first of uninterrupted sleep period and NP in elderly with nocturia; and 2) establish NP and duration of first uninterrupted sleep as mechanisms by which BBTI impacts nocturia. Our hypothesis is that BBTI improves nocturia not only by improving sleep, (and specifically, duration of the first uninterrupted sleep period), but also by decreasing NP. To accomplish our goals we will recruit 60 community dwelling adults (aged >65) with nocturia and NP. Sleep will be assessed subjectively with the Insomnia Severity Index and objectively by 7-day sleep diary and wrist actigraph. Concurrently we will collect 3-day bladder diary data to document their voiding pattern and volume during day and night. Participants will be randomized to receive the 4-week behavioral sleep intervention BBTI by a trained therapist or an information control intervention. The participants will repeat the study measures post-intervention. The study results will provide important insights into shared pathological mechanisms underlying poor sleep, nocturia and nighttime urine production. We will use these findings to construct a larger R01 to explore in the elderly biological mechanisms of NP, circadian rhythms of hormones regulating salt and water excretion, and the impact of sleep treatment on these rhythms.

项目概要 夜尿症是一个严重的问题，特别是对于老年人来说，这种现象普遍存在，发病率高，而且费用高昂（2012 年为每年 610 亿美元）。 它增加了跌倒、骨折、抑郁、安置在疗养院和死亡的风险。 大多数夜尿症的行为和药物治疗都集中在与膀胱相关的问题上。 病因，最常见的原因是夜间多尿 (NP)，即睡眠期间尿量增加 在过去的 50 年里，人们对这一问题的理解和处理仍然不够充分，而且几乎没有取得什么进展。 在老年人中，夜间排尿量增加的现象很常见。 年轻人表明，睡眠在调节老年人夜间尿液产生方面发挥着关键作用 睡眠不良在 NP 中的作用尚未得到充分研究。 尿液的产生遵循昼夜节律模式，其中从清醒到睡眠的转变之后是明显的 水、电解质和其他渗透活性物质的排泄减少 对年轻人的研究。 人们已经确定生理尿液的产生遵循昼夜节律，这是受到调节的 通过控制水和盐排泄的激素（例如精氨酸加压素）分泌的昼夜变化， 肾素-血管紧张素-醛固酮系统和心房钠尿肽会减弱夜间的激增。 这些激素会改变水和盐的排泄，从而增加夜间尿量 导致 NP。 最近的证据表明，睡眠质量差，经常睡眠中断，尤其是在睡眠的前半部分。 夜间睡眠时间短和第一次不间断睡眠时间较短与 NP 相关，但其病理生理学是 此外，我们还发现，在睡眠不佳的老年人中，行为存在着一定的差异。 仅针对睡眠的干预措施（BBTI-失眠的简短行为治疗和有效方法） 失眠的多模式行为治疗不仅可以改善睡眠，还可以改善夜尿症。 睡眠前半部分的睡眠中断会影响夜间尿液的荷尔蒙调节 此外，我们假设干预措施可以延长第一次不间断的睡眠。 经期会减少 NP，从而减少夜尿。 本提案的目的是： 1) 检查 BBTI 对第一个持续时间的影响 夜尿症老年人的不间断睡眠时间和 NP；2) 建立 NP 和首次持续时间； 不间断的睡眠是 BBTI 影响夜尿的机制。我们的假设是 BBTI 可以改善夜尿。 夜尿症不仅可以通过改善睡眠（特别是第一个不间断睡眠期的持续时间）来改善，还可以通过改善睡眠来改善。 通过减少 NP。 为了实现我们的目标，我们将招募 60 名患有夜尿症和 NP 的社区居民（年龄 > 65 岁）。 将通过失眠严重程度指数进行主观评估，并通过 7 天睡眠日记和腕带进行客观评估 同时，我们将收集 3 天的膀胱日记数据以记录其排尿模式和体积。 参与者将在白天和晚上随机接受为期 4 周的行为睡眠干预 BBTI。 由训练有素的治疗师或信息控制干预措施参与者将重复研究措施。 干预后。 研究结果将为睡眠不良背后的共同病理机制提供重要见解， 我们将利用这些发现构建更大的 R01 来探索。 NP的老年生物学机制、调节盐和水排泄的激素的昼夜节律，以及 睡眠治疗对这些节律的影响。