Aging: Cytokine Mechanisms and Treatment of Insomnia

描述(申请人提供)：失眠是晚年的一个突出症状。然而，几乎没有科学努力来确定与睡眠异常有关的生物学机制，或者评估行为疗法对老年人失眠的疗效。基本观察表明，促炎细胞因子在睡眠调节中起着关键作用。我们将细胞因子-睡眠机制转化为临床研究表明，细胞因子与睡眠异常是相互关联的。这项拟议的研究建立在这些发现的基础上，并扩展了一项研究计划，该计划检查了行为干预对老年人健康结果的有效性。初步研究表明，太极拳(TCC)是一种缓慢运动的冥想，有助于改善社区老年人的主观睡眠质量、睡眠时间和睡眠效率，改变交感神经活动，减少促炎细胞因子，并改善健康功能。此外，认知行为疗法(CBT)对睡眠结果也有好处。在这项随机对照试验中，150名老年人将被随机分配到CBT、TCC或睡眠卫生/教育对照组(EC)，为期16周，并跟踪观察一年。本项目的目的是：1)评估CBT与TCC与EC相比对失眠老年人客观和主观睡眠指标以及疲劳、情绪和健康功能的影响；2)确定CBT与TCC与EC相比对促炎细胞因子活性和交感迷走神经平衡的影响，以及这两种生物机制是否与治疗试验期间睡眠障碍的变化有关；以及3)评估促炎症细胞因子的循环水平是否与治疗试验期间患有失眠的老年人的睡眠连续性指标有关。这项研究将推进睡眠障碍的心理生物学模型，以及两种易于输出的行为干预措施的潜在好处，以促进老年人睡眠结果的改善。

DESCRIPTION (provided by applicant): Insomnia is a prominent complaint in late-life. However, little scientific effort has been directed toward identifying the biological mechanisms that are related to abnormal sleep or to evaluating the efficacy of behavioral treatments for insomnia in older adults. Basic observations demonstrate that proinflammatory cytokines play a key role in the regulation of sleep. Our translation of cytokine-sleep mechanisms into the clinic show that cytokines are reciprocally linked with abnormal sleep. The proposed research builds upon these findings and extends a program of study that has examined the efficacy of behavioral interventions on health outcomes in the elderly. Preliminary studies show found that Tai Chi Chih (TCC), a slow moving meditation, contributes to improvements in subjective sleep quality, sleep amounts and sleep efficiency, alterations in sympathetic activity, decreases in proinflammatory cytokines, and improvements in health functioning in community-dwelling older adults. Additionally, cognitive behavior therapy (CBT) confers benefits on sleep outcomes. In this randomized, controlled trial, 150 older adults will be randomly assigned to CBT, TCC, or sleep hygiene/ education control (EC) over 16 weeks and followed for one year. The aims of this project are to: 1) evaluate the effects of CBT vs TCC vs. EC on objective and subjective measures of sleep and on fatigue, mood, and health functioning in older adults with insomnia; 2) determine the effects of CBT vs.TCC vs. EC on measures of proinflammatory cytokine activity and sympathovagal balance, and whether these two biological mechanisms are related to changes of disordered sleep over the course of the treatment trial; and 3) evaluate whether circulating levels of proinflammatory cytokines are associated with measures of sleep continuity in older adults with insomnia over the treatment trial. This study will advance psychobiological models of disordered sleep and the potential benefits of two readily exportable behavioral interventions for promoting improvements in sleep outcomes in the elderly.