The Impact of Sleep Disordered Breathing in People who use Opioids

睡眠呼吸障碍对阿片类药物使用者的影响

• 批准号: 10433828
• 负责人: Jeremy Elliot Orr
• 金额: $ 16.99万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10433828
• 关键词: Acetazolamide; Address; Adverse effects; Affect; American; Analgesics; Apnea; Ataxia; Award; Breathing; Brief Pain Inventory; California; Caring; Central Sleep Apnea; Chest; Chronic; Clinical Research; Clinical Trials; Complex; Continuous Positive Airway Pressure; Critical Care; Cross-Over Trials; Data; Development Plans; Disease; Doctor of Medicine; Dose; Event; Excess Mortality; Faculty; Failure; Fellowship; Foundations; Funding; Goals; Health; Hypoventilation; Impairment; Individual; Knowledge; Laboratories; Lead; Link; Measures; Mediating; Medical; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Moods; Morbidity - disease rate; National Research Service Awards; Opioid; Outcome; Overdose; Oxygen; Pain; Pathogenesis; Patients; Persistent pain; Pharmaceutical Preparations; Pharmacotherapy; Physicians; Physiology; Placebos; Polysomnography; Public Health; Pulmonology; Quality of life; Randomized; Research; Research Personnel; Research Support; Respiration Disorders; Respiratory physiology; Risk; Science; Scientist; Signal Transduction; Sleep; Sleep Apnea Syndromes; Sleep disturbances; Societies; Specialist; Supervision; Symptoms; Techniques; Treatment Failure; United States Dept. of Health and Human Services; United States National Institutes of Health; Universities; adverse outcome; base; career development; chronic pain; chronic pain patient; comorbidity; comparative effectiveness; high risk population; improved; indexing; individualized medicine; member; mortality; mortality risk; opioid use; opioid user; patient oriented; patients who use opioids; personalized approach; poor sleep; prescription opioid; primary outcome; professor; prospective; public health emergency; randomized trial; research and development; respiratory; secondary outcome; sleep physiology; sleep quality; statistics; symptomatic improvement; treatment as usual; treatment risk; treatment strategy; trial design; ventilation

Project Summary/Abstract This proposal details a five-year research and career development plan for Jeremy E. Orr, M.D., a specialist in pulmonology and critical care medicine, and Assistant Professor of Medicine at the University of California, San Diego. His research has been supported by a National Research Service Award fellowship and currently an American Thoracic Society Foundation award. The overall focus of his research is understanding the importance of breathing issues during sleep in patients using chronic opioid medications, and identifying treatment strategies for these complex breathing issues that will improve health. This K23 award will provide necessary support for Dr. Orr to gain expertise in patient-oriented clinical research, applied physiology of sleep disordered breathing, and clinical trials. Dr. Orr has assembled a comprehensive team of mentors to support his research and career development. His primary mentor, Dr. Atul Malhotra, is a world expert in sleep disordered breathing (SDB) and applied respiratory physiology, with a strong track record of mentoring and promoting junior faculty to become independent investigators. Dr. Robert Owens is a NIH-funded physician-scientist with expertise in advanced techniques to measure SDB physiology, and will serve as a “hands-on” co-mentor. Additional members of the team are Dr. Sonia Jain (statistics and trials), Dr. Mark Wallace (opioids and pain), Dr. Shamim Nemati (signal analysis), and Dr. Frank Powell (control of breathing). Patients with chronic pain who use chronic opioids are at increased risk for poor health including ongoing pain, poor sleep, decreased quality of life, and an increased risk of mortality. Opioids are known to have effects on breathing which may lead to SDB, an under-recognized factor potentially contributing to adverse outcomes in these patients. SDB contributes to sleep disruption and impairments in oxygen levels, but has been little studied in this high-risk group of patients using opioids. In a broad group of subjects with chronic pain who use chronic opioids, this research will determine whether treatment of SDB with continuous positive airway pressure (CPAP) leads to improved sleep quality, as well as investigating other symptoms including pain in these patients (Aim 1). CPAP treatment may not be effective in some patients due to unstable breathing (due to opioids), so techniques to identify such individuals will be investigated, including new measures of breathing instability. For patients with persistent SDB despite CPAP, treatment options are limited. The research will evaluate whether a medication (acetazolamide) that helps to reduce the instability of breathing will help to resolve SDB (Aim 2). This research will provide Dr. Orr with a strong foundation to become an independent investigator studying the impact, pathogenesis and treatment of SDB in those using chronic opioids.

项目总结/摘要 这份提案详细介绍了杰里米·E.奥尔医学博士，的专家 他是加州大学旧金山分校医学助理教授， 迪亚哥他的研究得到了国家研究服务奖奖学金的支持，目前是 美国胸科学会基金会奖。他研究的重点是理解 使用慢性阿片类药物的患者睡眠期间的呼吸问题，并确定治疗策略 来解决这些复杂的呼吸问题，从而改善健康状况。K23项目将为以下方面提供必要的支持： 博士奥尔获得专业知识，以病人为导向的临床研究，应用生理学的睡眠呼吸障碍， 和临床试验。Orr博士组建了一个全面的导师团队来支持他的研究和职业生涯 发展他的主要导师Atul Malhotra博士是睡眠呼吸障碍（SDB）的世界专家， 应用呼吸生理学，具有指导和促进初级教师成为 独立调查员。罗伯特·欧文斯博士是NIH资助的医生科学家，拥有先进的专业知识。 技术来测量SDB生理，并将作为一个“动手”的共同导师。增补成员 小组成员有Sonia Jain博士（统计和试验）、Mark Wallace博士（阿片类药物和疼痛）、Shamim Nemati博士（信号 Frank Powell博士（呼吸控制）。使用慢性阿片类药物的慢性疼痛患者在 健康状况不佳的风险增加，包括持续疼痛、睡眠不佳、生活质量下降和风险增加 死亡率。已知阿片类药物对呼吸有影响，可能导致SDB，这是一个未被认识到的因素 可能导致这些患者的不良结局。SDB导致睡眠中断， 氧水平的损害，但很少在使用阿片类药物的高风险患者群体中进行研究。中 广泛的慢性疼痛受试者谁使用慢性阿片类药物，这项研究将确定是否治疗 持续气道正压通气（CPAP）可改善睡眠质量， 这些患者的其他症状包括疼痛（目标1）。CPAP治疗可能对某些患者无效 由于不稳定的呼吸（由于阿片类药物），因此将研究识别这些个体的技术， 包括呼吸不稳定的新措施。对于持续性SDB患者，尽管使用CPAP，治疗 选择有限。这项研究将评估是否有一种药物（乙酰唑胺），有助于减少 呼吸不稳定将有助于解决SDB（目标2）。这项研究将为奥尔博士提供坚实的基础 成为一名独立的研究者，研究SDB在使用者中的影响、发病机制和治疗。 慢性阿片类药物