Predictors of Response to Insomnia Treatments for Gulf War Veterans

 描述（由申请人提供）： 本申请由医学博士杰罗姆耶萨维奇提交，VISN 21精神疾病研究，教育和临床中心（MIRECC）在VA帕洛阿尔托医疗保健系统主任。VISN 21 MIRECC有着悠久的研究历史，致力于解决退伍军人的睡眠障碍问题，包括几个关于退伍军人失眠的研究项目。近年来，超过650名退伍军人事务部心理健康临床医生接受了VISN 21 MIRECC的CBT-I培训。Yesavage博士将与三个战争相关疾病和伤害研究中心（WRIISCs）合作，专注于海湾战争退伍军人（GWVs）的失眠认知行为疗法（CBT-I），试图将CBT-I“个性化”到这些退伍军人所经历的失眠类型。CBT-I的组成部分通常包括行为干预和认知治疗。常用的行为干预是睡眠限制（SR），其被设计为将“在床上花费的过多时间”减少到受试者的实际睡眠时间量，从而增加睡眠压力，导致更高质量的睡眠。失眠症的认知疗法（CT），就像其他疾病的CT一样，专注于改变干扰睡眠的侵入性想法。主要假设是这些治疗的疗效将取决于个体受试者的基线特征。对于SR，我们预期“在床上花费过多时间”的基线测量可以预测反应，对于CT，我们预期认知唤醒和疼痛的基线测量可以预测反应。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调节剂措施的潜在有用性。研究将分两组进行，每组50个全球WVs。将使用失眠严重程度指数、睡眠日志、生活质量指标以及相关中介和调节指标对SR和CT进行比较。最终，这项研究的结果将允许接受CBT-I培训的VA临床医生为GWV患者分配失眠的最佳治疗。

 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.