A Sleep Intervention to Improve Rehabilitation in Veterans with Chronic mTBI

睡眠干预可改善慢性 mTBI 退伍军人的康复

• 批准号: 9918162
• 负责人: Jonathan E Elliott
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9918162
• 关键词: Adverse effects; Chronic; Circadian Rhythm Sleep Disorders; Circadian Rhythms; Communities; Data; Development; Diffuse; Effectiveness; Excessive Daytime Sleepiness; Feasibility Studies; Future; General Population; Headache; Healthcare Systems; Home environment; Impairment; Individual; Intervention; Light; Literature; Measures; Meta-Analysis; Methods; Monitor; Nonpharmacologic Therapy; Outcome; Outcome Measure; Overdose; Pain; Pain Threshold; Pain intensity; Pain interference; Pain quality; Pathogenesis; Patient Self-Report; Pharmacology; Phototherapy; Population; Prevalence; Protocols documentation; Public Health; Publishing; Quality of life; Questionnaires; Randomized; Recording of previous events; Rehabilitation therapy; Reporting; Research; Severities; Sleep; Sleep disturbances; Sleeplessness; Testing; Time; Training; Traumatic Brain Injury; Treatment Effectiveness; United States National Institutes of Health; Veterans; Work; World Health Organization Disability Assessment Schedule; actigraphy; base; chronic pain; conditioned pain modulation; cost effective; design; disability; economic impact; effective therapy; follow-up; functional disability; functional outcomes; improved; indexing; innovation; mild traumatic brain injury; pain reduction; post intervention; prescription opioid addiction; pressure; prevent; primary outcome; recruit; rehabilitation strategy; rehabilitative care; sleep quality

Each year ~2.5 million people sustain a traumatic brain injury (TBI). Also a prominent general public health issue, TBI is particularly prevalent in Veterans, with 60-80% reporting a history of TBI. Over 80% of all TBI are categorized as mild TBI (mTBI), which is associated with a myriad of short- and long-term complications. Two of the principal complicating factors associated with mTBI are sleep-wake disturbances (e.g., insomnia, excessive daytime sleepiness, and circadian rhythm sleep disorders) and chronic pain, including headache and diffuse/global pain. Sleep-wake disturbances and chronic pain have an independent prevalence of ~70%, individually impair quality of life, impede effective rehabilitation, and have staggering economic impacts. Furthermore, there is a strong bidirectional relationship between sleep-wake disturbances and pain such that impaired sleep exacerbates pain, which leads to greater impairments in sleep and worse pain. This vicious cycle between sleep disturbances and pain, which is a particularly prevalent and detrimental condition in Veterans with chronic mTBI, represents a central challenge precluding effective treatment and ultimately, improving Veteran quality of life. Although there are pharmacological and non-pharmacological therapies for chronic pain, the presence of TBI significantly complicates the effectiveness of these treatment options, and have significant adverse effects (e.g., long-term prescription opioid dependence, misuse, and overdose). We believe there is profound potential to intervene at the sleep level, and, by improving sleep quality, enable Veterans with chronic mTBI to better manage their pain and end this vicious cycle. This proposal aims to apply a sleep intervention to improve chronic pain in Veterans with mTBI. We propose to use morning bright light therapy (MBLT), a readily deployable, cost-effective, non-pharmacologic, and home- based sleep intervention, to improve sleep-wake disturbances and therefore ameliorate chronic pain and improve quality of life in Veterans with chronic mTBI. There is substantial scientific precedent for MBLT to be effective in improving sleep quality, as outlined by a recent meta-analysis of 53 MBLT-based studies. Indeed, the potential of MBLT to improve sleep quality in Veterans with chronic mTBI remains unexplored, and yet, highly promising, especially in light of our exciting preliminary data supporting study feasibility and potential effectiveness. Our central hypothesis is that MBLT will improve sleep quality and ameliorate pain, resulting in improved quality of life in Veterans with chronic mTBI. Specific aims designed to test our hypothesis are to determine the effect of MBLT on, 1) sleep, 2) pain, and 3) quality of life, in Veterans with chronic mTBI. We propose to recruit n = 100 Veterans with mTBI from the VA Portland Health Care System, randomized 1:1 to MBLT (10,000 lux light exposure for 30 min within 90 min of waking for 4-weeks) or a no-light sham-MBLT condition (as previously published using the same duration/timing). Sleep quality will be assessed through self-report questionnaires and 24/7 actigraphy monitoring. Pain will be evaluated through self-report questionnaires and two quantitative methods (conditioned pain modulation and pressure algometry). Quality of life will be measured through self-report questionnaires. Outcomes will be assessed pre- and post-intervention, and at a 3-month follow-up time point. It is expected the proposed work will demonstrate MBLT is a viable method for improving sleep quality, ameliorating chronic pain and improving quality of life, in Veterans with mTBI. Improvements in pain and quality of life will positively correlate with objective markers of improved sleep quality. These data would demonstrate, 1) an effective treatment option, alone or in combination with existing rehabilitative efforts, in Veterans with mTBI, and 2) sleep-wake disturbances may be implicated in the pathogenesis of these functional impairments, thereby establishing greater precedent for targeting sleep as a meaningful primary and/or adjunctive rehabilitative therapy.

每年约有250万人遭受创伤性脑损伤（TBI）。也是一个突出的一般公共卫生 TBI在退伍军人中特别普遍，60-80%的人报告有TBI病史。超过80%的TBI是 被归类为轻度TBI（mTBI），其与无数的短期和长期并发症相关。两 与mTBI相关的主要复杂因素是睡眠-觉醒障碍（例如，失眠， 白天过度嗜睡和昼夜节律睡眠障碍）和慢性疼痛，包括头痛 和弥漫性/全身性疼痛。睡眠-觉醒障碍和慢性疼痛的独立患病率约为70%， 个别地损害生活质量，妨碍有效恢复，并产生惊人的经济影响。 此外，睡眠-觉醒障碍和疼痛之间存在强烈的双向关系， 睡眠受损会加剧疼痛，从而导致更严重的睡眠障碍和更严重的疼痛。这种恶性 睡眠障碍和疼痛之间的周期，这是一个特别普遍和有害的条件， 患有慢性mTBI的退伍军人是一个中心挑战，阻碍了有效治疗，最终， 提高退伍军人的生活质量。虽然有药物和非药物治疗， 慢性疼痛，TBI的存在显着复杂化这些治疗方案的有效性，和 具有显著的不利影响（例如，长期处方阿片类药物依赖、误用和过量）。我们 我相信，在睡眠水平上进行干预有着巨大的潜力，通过改善睡眠质量， 患有慢性mTBI的退伍军人可以更好地管理他们的疼痛并结束这种恶性循环。 该提案旨在应用睡眠干预来改善mTBI退伍军人的慢性疼痛。我们建议 使用早晨明亮的光疗法（MBLT），一个容易部署，成本效益，非药物，和家庭， 基于睡眠干预，以改善睡眠-觉醒障碍，从而改善慢性疼痛， 改善慢性mTBI退伍军人的生活质量。有大量的科学先例MBLT是 有效改善睡眠质量，正如最近对53项基于MBLT的研究进行的荟萃分析所概述的那样。的确， MBLT改善患有慢性mTBI的退伍军人的睡眠质量的潜力仍然未被探索，然而， 非常有前途，特别是考虑到我们令人兴奋的初步数据支持研究的可行性和潜力， 有效性我们的中心假设是，MBLT将改善睡眠质量和减轻疼痛，导致 改善慢性mTBI退伍军人的生活质量。 旨在检验我们假设的具体目标是确定MBLT对1）睡眠，2）疼痛和3） 慢性mTBI退伍军人的生活质量。我们建议从VA招募n = 100名mTBI退伍军人 波特兰卫生保健系统，以1：1的比例随机分配至MBLT组（10，000 lux光照暴露30 min，90 min内 清醒4周）或无光假MBLT条件（如先前公开的使用相同的 持续时间/定时）。睡眠质量将通过自我报告问卷和24/7活动记录仪进行评估 监测.疼痛将通过自我报告问卷和两种定量方法进行评估 （条件性疼痛调节和压力痛觉测定）。生活质量将通过自我报告来衡量 问卷调查将在干预前后以及3个月随访时间点评估结局。 预计拟议的工作将证明MBLT是改善睡眠质量的可行方法， 改善mTBI退伍军人的慢性疼痛和改善生活质量。改善疼痛和质量 生活中的睡眠质量与睡眠质量改善的客观指标呈正相关。这些数据表明， 1)一个有效的治疗选择，单独或与现有的康复努力相结合，在退伍军人与 mTBI，和2）睡眠-觉醒障碍可能与这些功能障碍的发病机制有关， 从而建立了更大的先例，将睡眠作为有意义的主要和/或预防措施， 康复治疗