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

项目概要 心血管疾病 (CVD) 是成人艾滋病毒感染者 (ALHIV) 发病和死亡的主要原因，并且 吸烟是该人群中最重要的可改变的 CVD 危险因素。成功率 现有的戒烟干预措施相对较低。睡眠质量不佳在吸烟者中更为普遍 在 ALHIV 中流行，可能由戒烟尝试引起，预示着以前吸烟的复发 模式，并代表了发病率的平行途径，包括心血管疾病（CVD）增加 ALHIV 中。因此，不健康的睡眠可能会使戒烟变得更加困难，并增加心血管疾病的风险。 ALHIV 的风险和其他不良健康状况。然而，睡眠不佳可以通过非药物干预来解决， 我们小组的一项试点研究表明，睡眠健康干预可以提高戒烟率 添加到常规戒烟治疗中时。改善睡眠健康的机制 加强戒烟尚不清楚，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对改善睡眠健康和提高戒烟率的功效 ALHIV 的发病率，拟议的研究将补充经验支持的戒烟计划（6- 为期 15 周的伐尼克兰咨询计划）以及减少吸烟的睡眠训练方法 (STARS) 为吸烟者开发的干预措施。这种干预措施独特地解决了（1）现有的睡眠困难， 如果有的话，在戒烟之前可能与艾滋病毒状况或尼古丁使用有关； (2) 预防未来睡眠 戒烟和/或伐尼克兰带来的困难； (3)对睡眠效率和持续时间进行急性干预 参与者在计划中取得进展； （4）养成健康的睡眠习惯，发扬光大 超出干预范围。该方法基于治疗失眠的金标准方法（认知 失眠行为疗法），但包含许多针对该人群量身定制的新颖元素。星星 将与一般健康 (GH) 教育控制进行比较。该研究将招募 N=200 名 ALHIV 吸烟者 有兴趣戒烟的人。他们将被随机分为 STARS (N=100) 或 GH 戒烟组 （N=100）。该研究将衡量 STARS 与 GH 的功效，以改善客观测量的健康状况 睡眠指标，评估其对戒烟的影响以及 CVD 风险的其他指标，并确定 认知和情感变量是否介导睡眠健康与戒烟之间的关联。 这些研究的结果将提供实用信息以及睡眠健康如何影响机制的见解 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.