Predictors of Response to Insomnia Treatments for Gulf War Veterans

 描述(由申请人提供)： 本申请由退伍军人事务部帕洛阿尔托医疗保健系统VISN 21精神疾病研究、教育和临床中心(MIRECC)主任Jerome Yesavage医学博士提交。VISN 21 MIRECC对退伍军人的睡眠障碍有很长的研究历史，包括几个关于退伍军人失眠的研究项目。近年来，VISN 21 MIRECC对650多名退伍军人精神健康临床医生进行了CBT-I培训。Yesavage博士将与三个战争相关疾病和伤害研究中心(WRIISC)合作，重点研究海湾战争退伍军人(GWVS)的失眠认知行为疗法(CBT-I)，试图将CBT-I与这些退伍军人经历的失眠类型“个性化”。CBT-I的组成部分通常包括行为干预和认知治疗。一种常用的行为干预是睡眠限制(SR)，旨在将“在床上花费的过多时间”减少到受试者的实际睡眠时间，从而增加睡眠压力，从而获得更高质量的睡眠。认知疗法(CT)治疗失眠，就像CT治疗其他疾病一样，专注于改变干扰睡眠的侵入性想法。主要的假设是，这些治疗的效果将取决于个体受试者的基线特征。对于SR，我们预计“在床上时间过长”的基线测量可以预测反应，而对于CT，我们预计认知觉醒和疼痛的基线测量可能预测反应。使用信号检测技术的探索性分析将系统地比较和对比一些额外的潜在缓和措施的潜在有用性。这项研究将在两组中进行，每组50个GWV。SR和CT将使用失眠严重程度指数、睡眠记录、生活质量测量以及相关的中介和调节措施进行比较。最终，这项研究的结果将使接受过CBT-I培训的VA临床医生能够为GWV患者分配最佳的失眠治疗方案。

 DESCRIPTION (provided by applicant): This application is submitted by Jerome Yesavage, M.D., Director of the VISN 21 Mental Illness Research, Educational and Clinical Center (MIRECC) at the VA Palo Alto Health Care System. The VISN 21 MIRECC has a long research history addressing sleep disorders in Veterans including several research projects on insomnia in Veterans. In recent years over 650 VA mental health clinicians have been trained in CBT-I by the VISN 21 MIRECC. In collaboration with the three War Related Illness and Injury Study Centers (WRIISCs), Dr. Yesavage will focus on Cognitive Behavior Therapy for Insomnia (CBT-I) in Gulf War Veterans (GWVs) attempting to "personalize" CBT-I to the types of insomnia experienced by these Veterans. Components of CBT-I often include both behavioral interventions and cognitive therapy. A commonly used behavioral intervention is Sleep Restriction (SR) designed to reduce "excessive time spent in bed" to the actual amount of the subject's sleep time, thereby increasing sleep pressure that leads to higher quality sleep. Cognitive therapy (CT) for insomnia, like CT for other disorders, focuses on changing intrusive thoughts that interfere with sleep. The primary hypothesis is that the efficacy of these treatments will depend upon an individual subject's baseline characteristics. For SR, we expect that baseline measures of "excessive time spent in bed" may predict response, and for CT, we expect that baseline measures of cognitive arousal and pain may predict response. Exploratory analyses using signal detection techniques will systematically compare and contrast the potential usefulness of a number of additional potential moderator measures. The research will be conducted in two groups of 50 GWVs each. SR and CT will be compared using the Insomnia Severity Index, sleep logs, quality of life measures and relevant mediator and moderator measures. Ultimately the results from this study will allow VA clinicians trained in CBT-I to assign GWV patients to the optimal therapy for their insomnia.