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.

项目摘要 普遍，病态且昂贵（2012年为61亿美元），夜尿是一个主要问题，尤其是对于老年人而言。 它增加了跌倒，裂缝，抑郁，护士住所和死亡的风险。但是管理 夜尿仍然不足。夜尿的大多数行为和药物治疗都集中在与膀胱相关的 病因，它是夜间多尿（NP）或睡眠期间尿液产生的最普遍的属性 remains poorly understood and inadequately treated with little advancement over the last 50 years.破坏 昼夜极端模式，夜间尿液产生较高的老年人很常见。同时研究 年轻人表明，睡眠在注册夜间尿液中起着至关重要的作用 不良睡眠在NP中的作用不足。 尿液产生遵循昼夜节律的模式，在该模式中，从唤醒到睡眠的过渡随后是明显的 减少极端水，电解质和其他渗透活性物质。对年轻的研究 人口已经确定，尿液产生遵循昼夜节律，该节奏受到调节 通过控制水和盐排泄的激素分泌的昼夜变化，例如精氨酸加压素， 肾素 - 血管紧张素 - 醛固酮系统和心房纳地酸肽。睡眠剥夺钝了夜间夜间激增 这些骑兵，因此改变了水和盐分，从而增加了夜间尿量 通向NP。 最近的证据表明，睡眠质量较差，经常睡眠中断，尤其是在 夜晚和较短的第一次不间断睡眠期与NP有关，但其病理生理学是 不完全理解。此外，在睡眠不佳的老年人中，我们已经表明了行为 仅针对睡眠的干预措施（BBTi-短暂行为治疗失眠是有效的 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。因此，我们假设 睡眠第一部分的睡眠中断会影响夜间尿液的荷尔蒙调节 产生NP。此外，我们假设干预措施延长了第一个不间断的睡眠 周期将减少NP，因此会减少夜尿。 本提案的目的是：1）检查BBTI对第一个持续时间的影响 不间断的睡眠期和夜尿的NP； 2）建立NP和第一持续时间 不间断的睡眠是BBTI影响夜尿的机制。我们的假设是BBTI改善了 夜尿不仅是通过改善睡眠（特别是第一个不间断睡眠期的持续时间），而且还 通过减少NP。 为了实现我们的目标，我们将使用Nocturia和NP招募60名社区居住成年人（> 65岁）。睡觉 将通过失眠严重程度指数和7天的睡眠日记和作家客观地评估主观评估 Actigraph。同时，我们将收集为期3天的膀胱日记数据，以记录其空隙模式和音量 在白天和黑夜。参与者将被随机接受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。参与者将重复研究测量 干预后。 研究结果将为睡眠不良的共同病理机制提供重要的见解， 夜尿和夜间尿液产生。我们将使用这些发现来构建较大的R01，以探索 Elderly biologic mechanisms of NP, circadian rhythms of hormones reguing salt and water excretion, and 睡眠治疗对这些节奏的影响。