Prospective Assessment of The Etiology of Insomnia in Middle Aged & Elder Adults

描述（由申请人提供）：失眠在老年人中很常见，睡眠连续性障碍在老年人中的发生率几乎是总体人群的三倍。这种增加的患病率是重要的临床问题，因为失眠在广大人群中是新发和复发性精神病和内科疾病的风险因素。对于老年人来说，失眠的患病率增加可能会使他们更容易受到随着年龄增长而发生的疾病的影响。尽管如此，人们对 失眠的自然史，更少的是知道的因素，似乎独特的易感性，沉淀，和/或长期失眠的老年人。由于缺乏这一领域的工作，该领域没有关于新发急性和慢性失眠症的发病率数据和时间趋势，特别是在老年人中。此外，没有基于经验的评估被认为是中度/介导良好睡眠的维持、急性失眠的发生（和缓解/恢复）以及从急性失眠向慢性失眠的转变的因素。在缺乏这些数据的情况下，人们假设急性失眠是由于易感因素和急性压力（感知的或真实的威胁）之间的相互作用而发生的，慢性失眠是认知、行为和条件反射因素的结果。这些因素都没有进行过前瞻性评估，评估其对临床病程的相对贡献，或评估其如何随年龄变化。因此，我们建议在三个年龄组（中年[35至55岁]，年轻老年人[55至75岁]和老年人[75岁及以上]）中进行大规模，纵向，基于互联网的研究。每个年龄组（由500名睡眠良好者和500名急性失眠症患者组成）将通过国际民意调查机构招募，并在七个时间点（原始Zogby调查，摄入量，1个月，3个月，6个月，9个月和12个月）进行调查，内容涉及生活事件，睡眠连续性，健康，心理健康状况以及理论上可介导临床病程的其他因素。除了纵向自我报告评估外，还将从父母样本（费城地区当地）中招募90名急性失眠受试者（超过3年），参加两项基于实验室的研究（一次是急性失眠，另一次是受试者表现出缓解或慢性失眠）。实验室评估将包括两个晚上的多导睡眠图，每次排尿时收集尿液样本（以评估皮质醇和褪黑激素水平），以及注意力偏差测试方案的管理。该研究的主要目的是：1）描述三个年龄组中急性和慢性失眠的发病率; 2）评估哪些理论驱动因素最能解释（单独和组合）各种临床病程情景; 3）确定基于实验室的生物学测量是否区分各种临床病程情景

DESCRIPTION (provided by applicant): Insomnia is common among older adults with sleep continuity disturbance being nearly three times more common in the elderly than in the overall population. This increased prevalence is of significant clinical concern as insomnia represents, in the population at large, a risk factor for new onset and recurrent psychiatric and medical illness. For older adults, the increased prevalence of insomnia may serve to make them more vulnerable to the illnesses that occur with advancing age. Despite this, very little is known about the natural history of insomnia and still less is known about the factors that appear to uniquely predispose, precipitate, and/or perpetuate insomnia in the elderly. The lack of work within this area has left the field without incidence data and temporal trends regarding new onset acute and chronic insomnia in general and in specific in older adults. Furthermore, there is no empirically based assessment of the factors that are thought to moderate/mediate maintenance of good sleep, the occurrence of (and remission/recovery from) acute insomnia, and the transition from acute to chronic insomnia. In the absence of such data, it has been hypothesized that acute insomnia occurs as an interaction between predispositional factors and acute stress (perceived or real threat) and that chronic insomnia occurs as a result of cognitive, behavioral, and conditioning factors. None of these sets of factors have ever been assessed prospectively, assessed for their relative contribution to clinical course, or assessed for how they vary with age. Accordingly, we propose to conduct a large scale, longitudinal, internet-based study across three age cohorts (middle aged [35 to 55 years], Young Elders [55 to 75 years], and Older Elders [75 years and older]). Each age cohort (comprised of 500 good sleepers and 500 individuals with acute insomnia) will be recruited via an international polling agency and surveyed on seven occasions (original Zogby survey, Intake, one, three, six, nine and 12 months) regarding life events, sleep continuity, health, mental health status, and other factors that have been theorized to mediate clinical course. In addition to the longitudinal self-report assessment, a sample of 90 subjects (over three years) with acute insomnia will be recruited from the parent sample (local to the Philadelphia region) to take part in two lab-based studies (once when the insomnia is acute and then again when the subject exhibits remission or chronic insomnia). The lab assessment will include two nights of polysomnography, the collection of urine samples at each void (to assess cortisol and melatonin levels), and the administration of an attention bias test regimen. The primary aims of the study are to: 1) profile the incidence rates of acute and chronic insomnia across the three age cohorts; 2) assess which of the theory driven factors best accounts for (alone and in combination) the various clinical course scenarios; and 3) determine if lab based biological measures distinguish between the various clinical course scenarios