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

描述(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几乎是总人口的三倍。由于失眠在一般人群中是新发病和反复发作的精神疾病和内科疾病的危险因素，这种增加的患病率是临床上令人严重关切的问题。对于老年人来说，失眠患病率的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，人们对此知之甚少 失眠的自然历史以及似乎独特地诱发、诱发和/或持久老年人失眠的因素更是鲜为人知。由于缺乏这方面的工作，该领域没有关于新发急性和慢性失眠的一般情况和具体情况的发病率数据和时间趋势。此外，对于被认为适度/适度维持良好睡眠、急性失眠的发生(和缓解/恢复)以及从急性失眠向慢性失眠过渡的因素，没有基于经验的评估。在缺乏这样的数据的情况下，人们假设急性失眠是由于易感因素和急性压力(感知或实际威胁)之间的相互作用而发生的，而慢性失眠是认知、行为和条件因素的结果。这些因素中没有一个是前瞻性评估的，没有评估它们对临床病程的相对贡献，也没有评估它们如何随年龄变化。因此，我们建议在三个年龄组(中年[35岁至55岁]、青年老年人[55岁至75岁]和老年老年人[75岁及以上])中进行一项大规模、纵向、基于互联网的研究。每个年龄组(包括500名睡眠良好的人和500名急性失眠症患者)将通过一家国际民意调查机构招募，并在七个场合(最初的佐格比调查、摄入量、1、3、6、9和12个月)进行调查，内容涉及生活事件、睡眠连续性、健康、心理健康状况和其他已被理论认为可以调节临床进程的因素。除了纵向自我报告评估外，还将从父母样本(费城地区当地)招募90名急性失眠患者(超过三年)的样本，参加两项以实验室为基础的研究(一次是在失眠严重时，另一次是在受试者表现出缓解或慢性失眠时)。实验室评估将包括两个晚上的多导睡眠图，在每个空隙收集尿样(以评估皮质醇和褪黑素水平)，以及实施注意力偏向测试方案。这项研究的主要目的是：1)描述三个年龄段的急性和慢性失眠的发生率；2)评估哪一种理论驱动因素最能解释不同的临床病程情景；以及3)确定基于实验室的生物测量是否区分不同的临床病程情景。

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