Aging Well, Sleeping Efficiently

描述（由申请人提供）：本申请是项目资助POI AG020677（“老化良好，睡眠有效”）第06年至第10年竞争性续期的修订版本（A1）。老年人失眠是一种普遍存在的健康状况，与严重的痛苦、功能损害、医疗保健利用率增加和高财务成本有关。该项目的目的是确定老年人失眠的新的生理、电生理、遗传和功能神经解剖学相关性。所有项目都将使用认知行为治疗失眠（CBTI），作为一项“干预挑战”，以确定失眠症状的变化如何影响失眠的相关因素。该项目有四个相互关联的项目和三个核心，研究了120名接受CBTI治疗的失眠症老年人（OAI），以及100名人口统计学上平衡的睡眠良好者（GS）。所有参与者为60岁以上；男女都将被研究。项目1-3将分别检查参与者的一个子集。招募参与者的广告将由Core A （Administration - Monk）提供。所有参与者将被招募，电话预筛选，同意筛选并使用核心B（临床核心- Buysse/Germain）资源进行筛选，然后使用核心C（数据管理和统计- Mazumdar/Hall）提供的程序分配到三个不同的项目之一。所有参与者都将为项目4 {Genetics - Nimgaonl<at]做出贡献。核心B也将负责提供CBTI和收集临床变量。核心A将提供一般管理；Core C将处理数据分析和统计。项目1{昼夜节律/体内平衡- Monk/Buysse)将涉及使用睡眠剥夺挑战对昼夜节律和睡眠体内平衡进行实验室评估；项目2{高唤醒-霍尔)将使用一系列实验室挑战来评估心理生理唤醒的动态特性；项目3 {PET成像- Nofzinger)将涉及非快速眼动睡眠和清醒期间的PET成像。项目4{遗传学- nimgaonkar)将检查Per3基因的多态性和功能特性，检查这些多态性与行为和生理变量之间的关系。所有四个组成部分项目基本上有两个主要目的：1)在他们感兴趣的特定领域内调查老年人失眠的基线相关性；2)确定这些相关性是否也与非药物治疗失眠（CBTI）的成功程度有关。该项目将显著提高我们对老年人失眠症及其治疗的认识。

DESCRIPTION (provided by applicant): This application is a revised version (A1) of a competing renewal for years 06 through 10 of program project grant POI AG020677 ("Aging Well, Sleeping Efficiently"). Insomnia in older adults is a widely prevalent health condition that is associated with significant distress, functional impairment, increased utilization of healthcare, and high financial costs. The aim of the program is to identify novel physiological, electrophysiological, genetic and functional neuroanatomical correlates of insomnia in older adults. All projects will use treatment with Cognitive Behavioral Treatment of Insomnia (CBTI), as an "intervention challenge" to determine how changes in insomnia symptoms affect these correlates of insomnia. The program has four inter-related projects and three cores examining a group of 120 Older Adults with Insomnia (OAI) all receiving CBTI, as well as a demographically balanced group of 100 good sleepers (GS). All participants will be 60y+; both genders will be studied. Projects 1-3 will each examine a subset of the participants. Advertising for participant recruitment will be provided by Core A {Administration - Monk). All participants will be recruited, telephone pre-screened, consented for screening and screened using Core B (Clinical core - Buysse/Germain) resources, and then assigned to one of three different projects using procedures provided by Core C {Data Management and Statistics - Mazumdar/Hall). All participants will contribute to Project 4 {Genetics - Nimgaonl<at). Core B will also be responsible for delivering the CBTI and collecting clinical variables. Core A will provide general administration; Core C will handle data analysis and statistics. Project 1 {Circadian/homeostatic - Monk/Buysse) will involve a laboratory evaluation of circadian rhythms and sleep homeostasis using a sleep deprivation challenge; Project 2 {Hyperarousal - Hall) will use a series of laboratory challenges to evaluate the dynamic properties of psycho-physiological arousal; Project 3 {PET imaging - Nofzinger) will involve PET imaging during NREM sleep and wakefulness. Project 4 {Genetics-Nimgaonkar) will examine polymorphisms and functional properties of the Per3 gene, examining correlations between these polymorphisms and behavioral and physiologic variables. All four of the component projects essentially have two major aims: 1) to investigate baseline correlates of insomnia in older adults within their particular domain of interest; and 2) to determine whether these correlates also relate to the level of success of a non-pharmacological treatment for insomnia (CBTI). This Program Project will significantly advance our understanding of insomnia and its treatment in older adults. PUBLIC HEALTH RELEVANCE: Insomnia in older adults is associated with significant distress, functional impairment, increased utilization of healthcare resources, and high financial costs. These will all increase as the baby-boomer generation ages. The relevance of this research on older adults derives from the massive prevalence of insomnia in this population, the age-related changes in physiology and brain morphology that are relevant to sleep-wake processes, and the many co-morbidities that advancing age is often heir to. REVIEW OF INDIVIDUAL COMPONENTS OF THE PROGRAM PROJECT CORE A - ADMINISTRATION; Dr. Timothy Monk, Core Leader (CL) DESCRIPTION (provided by applicant): Core A comprises the administrative core of the program project POI AG020677 "Aging well, sleeping efficiently" ("AgeWise"). It will provide the intellectual, organizational, and fiscal support essential for the development and maintenance of an effective program of research which seeks to understand the correlates of insomnia and its treatment in older adults. Core A will lead and coordinate the research, review, educational, and information dissemination activities, addressing all of the major management issues (other than data management) related to the four component projects and three cores in the AgeWise program. These are its specific aims: Administrative functions: To ensure the smooth running of the AgeWise program, facilitating the science to be accomplished in the four component projects and in the program as a whole; To provide a forum for the discussion of management issues relating to the three cores and their interaction with the four component projects; To provide resources needed for the provision of timely reports, applications and certifications as required by various local and national entities. This will also involve handling all issues related to the program's Data and Safety Monitoring Board (DSMB) and Data Sharing Plan (DSP); To ensure fiscal responsibility in the AgeWise program, and to provide mechanisms for advertising, participant payments, travel, and the ordering of equipment and supplies. Scientific support functions: To supervise all functions relating to advertising for participants; To promote scientific quality control by facilitating peer-review within the program and also ensuring appropriate consultation with program; To provide weekly Tuesday afternoon meetings of AgeWise faculty at which scientific issues can be discussed; To organize bi-weekly project coordinator meetings (for staff only) to discuss operational issues. To organize an annual scientific review of the AgeWise program using three external consultants meeting for one-and-a-half days towards the end of each of the five grant years. Training and outreach functions: To provide a training opportunity for undergraduates, medical students, fellows and junior faculty; To provide outreach to the community both as a means of disseminating knowledge that would be useful for seniors and as a means of attracting potential participants, with particular attention to minorities. Core A resources will be used to publicize the AgeWise program in the community through media announcements and speaking engagements. In conclusion, Core A will comprise the intellectual and administrative hub of the AgeWise program. PUBLIC HEALTH RELEVANCE: Insomnia in older adults is associated with significant distress, functional impairment, increased utilization of healthcare resources, and high financial costs. These will all increase as the baby-boomer generation ages The relevance of this research on older adults derives from the massive prevalence of insomnia in this population, the age-related changes in physiology and brain morphology that are relevant to sleep-wake processes, and the many co-morbidities that advancing age is often heir to.