Characterization of sleep with trauma nightmares using ambulatory sleep measurement

近90%的创伤暴露退伍军人报告了临床上严重的失眠和/或创伤相关 噩梦。除了对创伤后应激障碍(PTSD)的影响外，与创伤相关的噩梦还具有 对身体健康、物质使用和自杀行为的负面影响。迫切需要继续 研究以更好地理解这些现象，目标是制定个性化的治疗计划。 目前评估程序的局限性是改善护理的一个重大障碍。实验室内睡眠 研究很少捕捉噩梦，也无法评估随时间的变化，从而减少了我们对表型的了解 噩梦的标志物来指导治疗。因此，有必要评估几个晚上的睡眠情况 家庭环境，噩梦发生的地方。拟议的临床科学研究和发展 CDA-2旨在显著丰富创伤相关噩梦的知识，通过使用零负担、多 退伍军人通常睡眠环境中的夜间客观睡眠测量方法 针对噩梦的循证认知行为干预。这项研究的主要目的有两个：1) 比以前更精确地识别与创伤有关的睡眠的客观特征- 相关噩梦的发生；2)利用噩梦的治疗作为介入探查 确定目标1中确定的睡眠生理参数的变化是否和如何随变化而变化 在主观上噩梦的频率和严重程度。 这项研究将包括80名暴露于创伤的退伍军人，他们报告有与创伤相关的噩梦。合资格 参与者将使用实施的多夜床垫活动记录来监控他们的睡眠一周 回家。床垫动作记录仪，它使用嵌入床垫的加速度计测量运动 TOPER，不使用任何体表传感器。因此，该系统代表了一种真正的零负担方法 获得密集的纵向睡眠测量。在睡眠监测的一周内，参与者还将 完成一晚多导睡眠图(PSG)睡眠评估，以校准活动图睡眠效率。 这些方法将用于研究与创伤相关的候选生理参数 噩梦。在确定这些候选标记的水平后，该项目将评估 认知-行为治疗、暴露、放松和重写治疗(ERRT)，关于 在治疗过程中可以连续测量的标记物。参与者将被随机分配 至五周的积极治疗(ERRT；n=40)或至五周的对照治疗(睡眠和 噩梦管理；n=40)。在整个治疗过程中，参与者将继续睡眠，同时 由床垫动作记录系统监控。治疗结束后，进行一次后处理和随访 评估将评估主观症状的变化。 CDA-2的结果将提供重要的信息，以促进对 现象学、病理生理学和创伤暴露退伍军人噩梦的治疗。这个CDA-2也 将为申请者提供有针对性的睡眠生理学培训，高级纵向统计设计 和治疗研究方法，以及勇往直前的精神，为成功的退伍军人研究事业做准备 关于改善患有创伤相关睡眠障碍的退伍军人的生活质量。

Nearly 90% of trauma-exposed Veterans report clinically significant insomnia and/or trauma-related nightmares. Added to the impact on posttraumatic stress disorder (PTSD), trauma-related nightmares have a negative effect on physical health, substance use, and suicidal behaviors. There is a critical need for continued research to better understand these phenomena with the goal of developing personalized treatment plans. Limitations of current assessment procedures present a significant barrier to improved care. In-laboratory sleep studies rarely capture nightmares and cannot assess change over time, reducing our knowledge of phenotypic markers of nightmares to guide treatment. Therefore, there is a need to assess sleep over multiple nights in the home environment, where nightmares occur. The proposed Clinical Sciences Research and Development CDA-2 aims to significantly enrich knowledge about trauma-related nightmares by using a zero-burden, multi- night, objective sleep measurement method within Veterans’ usual sleeping environment prior to and during an evidence-based cognitive-behavioral intervention for nightmares. This study has two primary aims: 1) to identify, with greater precision than previously possible, objective features of sleep associated with trauma- related nightmare occurrences; and 2) to use the treatment for nightmares as interventional probes to determine whether and how changes in sleep physiological parameters identified in Aim 1 covary with changes in subjective nightmare frequency and severity. The study will include 80 trauma-exposed Veterans reporting with trauma-related nightmares. Eligible participants will monitor their sleep for a week using a multi-night mattress actigraphy implemented in their home. Mattress actigraphy, which measures movements using accelerometers embedded in a mattress topper, employs no body surface sensors. Therefore, this system represents a truly zero-burden method for obtaining intensive longitudinal sleep measurement. During the week of sleep monitoring, participants also will complete one-night of polysomnography (PSG) sleep assessment to calibrate the actigraphic sleep efficiency. These methods will be used to investigate candidate physiological parameters associated with trauma-related nightmares. After establishing the levels of these candidate markers, this project will assess the impact of a cognitive-behavioral treatment, Exposure, Relaxation, and Rescripting Therapy (ERRT), on the subset of markers which can be measured continuously over the course of the treatment. Participants will be randomized to five weeks of active treatment (ERRT; n = 40) or to five weeks of the comparison treatment (sleep and nightmare management; n = 40). Throughout the course of treatment, participants will continue to sleep while monitored by the mattress actigraphy system. Upon completion of treatment, a post-treatment and follow-up assessment will assess subjective symptom change. Results from this CDA-2 will provide important information to facilitate increased understanding of the phenomenology, pathophysiology, and treatment of nightmares in trauma-exposed Veterans. This CDA-2 also will provide the applicant with focused training in sleep physiology, advanced longitudinal statistical designs and treatment research methods, and grantsmanship to prepare for a successful VA research career focused on improving the quality of life for Veterans with trauma-related sleep disturbances.