Aging: Insomnia Treatment and Energy Balance

描述（由申请人提供）：超过50%的65岁以上的成年人报告睡眠问题，持续失眠症的患病率估计超过30%，并且随着年龄的增长而稳步上升。慢性失眠症的行为治疗已经证明了自我报告睡眠的持续改善，但结果评估，包括多导睡眠图，健康功能等行为因素和受睡眠影响的生物因素尚未得到全面检查，特别是在老年人中。特别是，一个有前景的研究领域是干预对能量平衡的影响。生长素和瘦素这两种激素被认为向大脑传递能量平衡的信息，而这些激素的失调会导致食欲增加和脂质积累。流行病学研究发现，睡眠不足与胃饥饿素升高和瘦素下降有关，这也得到了睡眠限制实验研究的证实。胃促生长素升高和瘦素降低也与交感神经活动增加有关；这在失眠患者中很常见。综上所述，这些发现表明老年失眠患者可能已经改变了能量平衡。然而，很少有研究测量失眠干预后的客观睡眠评估，也没有研究报告其对能量平衡的影响。该项目是一项新资助的NIA随机对照试验的辅助研究，比较认知行为疗法（CBT）、太极拳（TCC）和卫生/教育控制（EC）对老年失眠患者睡眠结果的影响。这个K23项目是PI（健康临床心理学家）利用睡眠和心理生理学评估方面的专业知识和以前的临床培训的机会，同时发展行为失眠治疗研究和治疗的生物学效应方面的专业知识。K23项目的独特目的是：1)评估CBT、TCC和EC在基线、治疗中、治疗后以及3个月和12个月随访时对胃饥饿素和瘦素水平的影响；2)确定CBT、TCC和EC在UCLA GCRC基线和治疗后睡眠评估期间对夜间自主神经功能（心率变异性的功率谱分析）的影响；3)检查能量平衡和自主神经功能是否与治疗试验过程中客观和主观睡眠测量的改善有关。

DESCRIPTION (provided by applicant): Over 50% of adults older than 65 years report problems sleeping and the prevalence of persistent insomnia is estimated to be over 30% in this population, and steadily increases with age. Behavioral treatments for chronic insomnia have demonstrated consistent improvements in self-reported sleep, but outcome assessment, including polysomnography, behavioral factors such as health functioning and biologic factors impacted by sleep have not been comprehensively examined, especially in older adults. In particular, one promising area of research is the impact of interventions on energy balance. The hormones ghrelin and leptin are thought to convey information about energy balance to the brain, and dysregulation of these hormones lead to increases in appetite and lipid accumulation. Epidemiologic studies have found that poor sleep is associated with elevated ghrelin and decreased leptin, corroborated by experimental sleep restriction studies as well. Elevated ghrelin and decreased leptin levels also correlate with increased sympathetic activity; which is seen in insomnia patients. Taken together, these findings indicate that older insomnia patients may have altered energy balance. Yet few studies have measured objective sleep assessment following insomnia interventions and no study has reported its effects on energy balance. The proposed project is an ancillary study to a newly funded NIA randomized, controlled trial comparing the effects of cognitive-behavioral therapy (CBT), Tai Chi Chih (TCC), and hygiene/education control (EC) on sleep outcomes in older insomnia patients. This K23 project is an opportunity for the PI (a health-clinical psychologist) to utilize expertise in sleep and psychophysiology assessment and previous clinical training while developing expertise in behavioral insomnia treatment research and biological effects of treatment. The unique aims of this K23 project are to: 1) evaluate the effects of CBT vs. TCC vs. EC on ghrelin and leptin levels at baseline, mid- treatment, post-treatment and 3- and 12-month follow-ups; 2) determine the effects of CBT vs. TCC vs. EC on nocturnal autonomic function (power spectral analysis of heart rate variability) during sleep assessments at the UCLA GCRC at baseline and post-treatment; 3) examine whether energy balance and autonomic function are related to improvements in objective and subjective measures of sleep over the course of the treatment trial.