Characterization of sleep with trauma nightmares using ambulatory sleep measurement

使用动态睡眠测量来描述创伤噩梦的睡眠特征

• 批准号: 10409711
• 负责人: Katherine Elizabeth Miller
• 金额: --
• 依托单位: PHILADELPHIA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10409711
• 关键词: Accelerometer; Address; Aftercare; Arousal; Attention; Attenuated; Behavioral; Biological Markers; Body Surface; Caring; Chest; Clinical; Clinical Research; Clinical Sciences; Cognitive; Cognitive Therapy; Data; Detection; Environment; Event; Evidence based treatment; Exclusion; Frequencies; Functional disorder; Goals; Home; Home environment; Intervention; Knowledge; Laboratories; Mattresses; Measures; Methodology; Methods; Monitor; Movement; Nightmare; Outcome; Parasympathetic Nervous System; Participant; Pattern; Physiological; Polysomnography; Post-Traumatic Stress Disorders; Procedures; Quality of life; REM Sleep; Randomized; Relaxation; Reporting; Research; Research Methodology; Sampling; Severities; Signal Transduction; Sinus Arrhythmia; Sleep; Sleep Apnea Syndromes; Sleep Stages; Sleep disturbances; Sleeplessness; Symptoms; System; Time; Training; Trauma; Veterans; actigraphy; active method; candidate marker; career; clinical care; clinically significant; design; eligible participant; evidence base; evidence based guidelines; follow up assessment; improved; multimodality; personalized medicine; personalized strategies; phenomenological models; phenotypic biomarker; physical conditioning; poor sleep; research and development; respiratory; response; sensor; sleep physiology; substance use; suicidal behavior; suicidal risk; symptom management; trauma exposure; traumatic stress; treatment comparison; treatment planning; treatment research; treatment response

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.

近 90% 遭受过创伤的退伍军人报告有临床上显着的失眠和/或与创伤相关的失眠 噩梦。除了对创伤后应激障碍（PTSD）的影响之外，与创伤相关的噩梦还对创伤后应激障碍（PTSD）产生影响。 对身体健康、药物使用和自杀行为产生负面影响。迫切需要继续 研究以更好地了解这些现象，以制定个性化的治疗计划。 当前评估程序的局限性对改善护理构成了重大障碍。实验室睡眠 研究很少捕获噩梦，也无法评估随时间的变化，从而减少了我们对表型的了解 噩梦的标记来指导治疗。因此，有必要评估多个夜晚的睡眠情况 家庭环境，噩梦发生的地方。拟议的临床科学研究与开发 CDA-2旨在通过使用零负担、多维度的方法来显着丰富有关创伤相关噩梦的知识。 晚上，在退伍军人通常的睡眠环境中进行客观睡眠测量的方法 针对噩梦的循证认知行为干预。这项研究有两个主要目的：1） 比以前更精确地识别与创伤相关的睡眠的客观特征 相关的噩梦事件； 2）使用噩梦治疗作为介入探针 确定目标 1 中确定的睡眠生理参数的变化是否以及如何随变化而变化 主观噩梦频率和严重程度。 该研究将包括 80 名遭受过创伤的退伍军人，他们报告了与创伤相关的噩梦。有资格的 参与者将使用在他们的睡眠中实施的多晚床垫体动记录仪来监测他们的睡眠一周。 家。床垫体动记录仪，使用嵌入床垫的加速度计测量运动 topper，不采用体表传感器。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 完成一晚的多导睡眠图 (PSG) 睡眠评估，以校准活动记录睡眠效率。 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、暴露疗法、放松疗法和重写疗法 (ERRT) 可以在治疗过程中连续测量的标记。参与者将被随机分配 持续五周的积极治疗（ERRT；n = 40）或持续五周的比较治疗（睡眠和睡眠） 噩梦管理； n = 40)。在整个治疗过程中，参与者将继续睡眠 由床垫体动记录系统监测。治疗完成后，进行治疗后和随访 评估将评估主观症状的变化。 CDA-2 的结果将提供重要信息，以促进加深对 遭受创伤的退伍军人的现象学、病理生理学和噩梦治疗。此 CDA-2 还 将为申请人提供睡眠生理学、高级纵向统计设计方面的重点培训 和治疗研究方法，以及为成功的 VA 研究事业做好准备的资助 改善患有创伤相关睡眠障碍的退伍军人的生活质量。