Using Sleep Health to Optimize Smoking Cessation Treatment Response in HIV-Positive Adults

项目摘要 心血管疾病(CVD)是成人艾滋病毒携带者(ALHIV)发病和死亡的主要原因， 吸烟是这一人群中唯一最重要的可改变的心血管疾病危险因素。成功的比率 现有的戒烟干预措施相对较低。睡眠不佳在吸烟者中更普遍，更多 在ALHIV中流行，可由戒烟尝试引起，预测再次吸烟 模式，并代表了一条平行的致病途径，包括增加的心血管疾病(CVD) 在ALHIV中。因此，不健康的睡眠可能会使戒烟变得更加困难，并增加心血管疾病 ALHIV的风险和其他糟糕的健康状况。然而，睡眠不佳是非药物干预的结果， 我们小组的一项初步研究显示，睡眠健康干预提高了戒烟率 当加入常规戒烟治疗时。改善睡眠健康的机制 促进戒烟尚不清楚，但改善认知和情感功能是两个候选方案。 评估我们的睡眠训练方法改善睡眠健康和增加戒烟的效果 ALHIV的发生率，这项拟议的研究将补充经验支持的戒烟计划(6- 疗程，为期15周的咨询计划，使用varenicline)和睡眠训练方法来减少吸烟 (STAR)为吸烟者开发的干预措施。这种干预独特地解决了(1)现有的睡眠困难， 如果有的话，在戒烟之前，这可能与艾滋病毒状况或尼古丁的使用有关；(2)为未来的睡眠接种疫苗 戒烟和/或varenicline带来的困难；(3)急性干预睡眠效率和持续时间 参与者通过该计划取得进步；以及(4)养成健康的睡眠习惯以发扬 在干预之外。这种方法是基于治疗失眠的黄金标准方法(认知法 失眠的行为疗法)，但包括一些为这一人群量身定做的新元素。星辰 将被比作普通健康(GH)教育控制。这项研究将招募N=200名ALHIV吸烟者 对戒烟感兴趣的人。他们将随机接受STAR(N=100)或GH的戒烟 100例。这项研究将衡量明星和生长激素对改善客观测量的健康状况的效果 睡眠指标，评估其对戒烟的影响以及其他心血管疾病风险指标，并确定 认知和情感变量是否在睡眠健康和戒烟之间起中介作用。 这些研究的结果将提供实用信息以及对睡眠健康如何 可用于优化ALHIV的戒烟治疗。

Project Summary Cardiovascular disease (CVD) is a major cause of morbidity and mortality in adults living with HIV (ALHIV), and cigarette smoking is the single most important modifiable CVD risk factor in this population. Success rates for existing smoking cessation interventions are relatively low. Poor sleep is more prevalent among smokers, more prevalent among ALHIV, can be caused by smoking cessation attempts, predicts relapse to former smoking patterns, and represents a parallel pathway to morbidity including increased cardiovascular disease (CVD) among ALHIV. Thus, unhealthy sleep may make smoking cessation more difficult and increase cardiovascular risk and other poor health conditions in ALHIV. Yet, poor sleep is amenable to nonpharmacologic interventions, and a pilot study from our group revealed that a sleep health intervention increased smoking cessation rates when added to routine smoking cessation treatment. The mechanisms by which improvements in sleep health enhance tobacco cessation are unknown, but improved cognitive and affective functioning are two candidates. To evaluate the efficacy of our sleep training approach to improve sleep health and increase smoking cessation rates in ALHIV, the proposed study will supplement an empirically-supported smoking cessation program (6- session, 15-week counseling program with varenicline) with a Sleep Training Approach to Reducing Smoking (STARS) intervention developed for smokers. This intervention uniquely addresses (1) existing sleep difficulties, if any, prior to quitting that may be associated with HIV status or nicotine use; (2) inoculation against future sleep difficulties brought on by quitting and/or varenicline; (3) acute intervention on sleep efficiency and duration as the participant progresses through the program; and (4) development of healthy sleep habits to carry forward beyond the intervention. This approach is based on the gold-standard approach to treating insomnia (Cognitive Behavioral Therapy for Insomnia) but includes a number of novel elements tailored to this population. STARS will be compared to a General Health (GH) educational control. The study will recruit N=200 ALHIV smokers who are interested in quitting. They will be randomized to smoking cessation with either STARS (N=100) or GH (N=100). The study will measure the efficacy of STARS versus GH to improve objectively measured healthy sleep metrics, assess its impact on smoking cessation as well as other metrics of CVD risk, and determine whether cognitive and affective variables mediate the association between sleep health and smoking cessation. Results of these studies will provide practical information as well as mechanistic insight into how sleep health can be leveraged to optimize smoking cessation treatment in ALHIV.