SEdative-Hypnotic Deprescribing Assisted by a Technology-Driven Insomnia InterVEntion (SEDATIVE)

技术驱动的失眠干预辅助镇静催眠处方（SEDATIVE）

• 批准号: 10363862
• 负责人: ADAM DANIEL BRAMOWETH
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10363862
• 关键词: Accidents; Address; Aftercare; Air; Artificial Intelligence; Behavior Therapy; Behavioral; Biological Process; COVID-19 pandemic; Caring; Chronic; Chronic Insomnia; Clinic; Clinical; Clinical Pharmacists; Clinical Psychology; Clinical Trials; Cognitive; Cognitive Therapy; Communication; Communities; Consultations; Dependence; Development; Diagnosis; Disease; Dreams; Effectiveness; Enrollment; Ensure; Evidence based intervention; Fatigue; Foundations; Funding; Health; Health Services Accessibility; Home; Impairment; Injury; Intervention; Link; Medical; Medical Societies; Medicine; Mental Health; Mental disorders; Methodology; Military Personnel; Outcome; Persons; Pharmaceutical Preparations; Pharmacists; Pharmacy (field); Pharmacy facility; Pilot Projects; Provider; Psychologist; Psychotherapy; Quality of life; Recommendation; Research; Risk; Schedule; Scientific Societies; Secure; Self Management; Services; Sleep; Sleep Disorders; Sleeplessness; Stimulus; Suicide prevention; Symptoms; Technology; Testing; Therapeutic; Time; Training; Translating; Transportation; Veterans; arm; barrier to care; base; care delivery; clinical practice; cloud based; common treatment; coronavirus disease; digital; digital health; digital intervention; effective intervention; effectiveness testing; evidence base; flexibility; functional disability; functional independence; functional outcomes; hypnotic; improved; innovation; mobile application; new technology; novel strategies; operation; patient home care; personalized care; pilot test; post intervention; recruit; rehabilitation research; research and development; sedative; sleep health; sleep quality; success; symptom treatment; symptomatic improvement; telehealth; usability; user-friendly

Background: Chronic insomnia, one of the most common health problems among Veterans increases risk for medical and psychiatric disorders, higher rates of accidents and injuries, and functional impairment. The most common forms of treatment are prescription sedative-hypnotic medications and cognitive behavioral therapy for insomnia (CBT-I), a multi-component psychotherapy. Despite strong evidence in support for CBT-I as the first line treatment, sedative-hypnotics remain the most common. Sedative-hypnotic use is linked to potential tolerance, dependence, and abuse as well as risk for daytime fatigue and cognitive and physical impairment. Furthermore, sedative-hypnotics treat symptoms while CBT-I focuses on the cognitive/behavioral causal factors. Notably, deprescribing sedative-hypnotics, which may help to reduce associated risk and improve Veteran function and quality of life, is often accompanied by the return or worsening of insomnia symptoms. Thus, to improve Veteran sleep outcomes, deprescribing and CBT-I should occur simultaneously. Furthermore, a telehealth-based intervention that combines CBT-I with deprescribing could result in improved Veteran sleep, function, and quality of life while also increasing access to care in an efficient and scalable manner. Significance/Impact: Both deprescribing and CBT-I are evidence-based interventions regularly delivered within VA; however, a combined intervention that can streamline care and optimize Veteran outcomes is not readily available. The Clinician Operated Assistive Sleep Technology (COAST) is an evidence-based, digital sleep platform that combines aspects of in-person CBT-I (personalized care) with the benefits of telehealth (in home care, flexible scheduling). COAST’s unique approach utilizes artificial intelligence to develop tailored recommendations and integrates provider expertise and personalized deprescribing in an easy to use, efficient, and scalable package. The proposed intervention has potential to significantly impact, and improve, Veteran health and the delivery of sedative-hypnotic deprescribing and CBT-I in VA. This proposal is consistent with VA RR&D’s scope to translate research into clinical practice in order to maximize Veterans’ functional independence, quality of life, and participation in their lives and community. Innovativeness: This pilot study is pragmatic and unique. There are currently no funded studies that combine deprescribing and CBT-I, delivered by a scalable and efficient digital platform like COAST. Focusing on sleep and functional outcomes will also ensure that this intervention can improve Veterans’ functional capabilities and quality of life in addition to the reduction of clinical symptoms and improvement of care delivery. Specific Aims: Aim 1 will assess the feasibility of recruiting Veterans with chronic sedative-hypnotic use and their participation in a dual deprescribing and insomnia intervention, delivered through a digital health platform. Aim 2 will assess Veterans’ acceptability and usability of the COAST platform. Aim 3 will assess change in Veteran insomnia, sedative-hypnotic use, and clinical and functional outcomes pre- to post-intervention. Methodology: This single-arm, 12-week intervention will recruit and enroll 50 Veterans with chronic sedative- hypnotic medication use, a desire to reduce these medications, and ability to participate in a digital health intervention. Feasibility will be based on recruitment and participation. Assessments of acceptability/usability, and clinical and functional outcomes will occur at baseline, post-treatment, and 3-months post-treatment. Next Steps: Findings will be used to inform the development of a larger, appropriately powered clinical trial to test the effectiveness of COAST to deliver CBT-I and integrated pharmacist-led deprescribing to improve Veteran sleep and function and reduced use of sedative-hypnotic medications. Also, next steps will include efforts to better understand the factors that help or hinder Veterans’ use of digital interventions. Future research efforts will involve VA operations partners (e.g., Office of Mental Health and Suicide Prevention, Telehealth Services) and Veteran advisory groups to ensure the needs of Veterans and VA are met.

背景：慢性失眠是退伍军人最常见的健康问题之一， 医疗和精神疾病，事故和伤害发生率较高，以及功能受损。最 常见的治疗形式是处方镇静催眠药物和认知行为疗法 失眠症（CBT-I），一种多成分的心理疗法。尽管有强有力的证据支持CBT-I作为 在一线治疗中，镇静催眠药仍然是最常见的。镇静催眠药的使用与潜在的 耐受性、依赖性和滥用以及日间疲劳和认知及身体损害的风险。 此外，镇静催眠药治疗症状，而CBT-I侧重于认知/行为因果关系 因素值得注意的是，取消镇静催眠药的处方，这可能有助于降低相关风险， 退伍军人的功能和生活质量，往往伴随着失眠症状的复发或加重。 因此，为了改善退伍军人的睡眠结果，取消处方和CBT-I应该同时进行。此外，委员会认为， 结合CBT-I和取消处方的远程医疗干预可能会改善退伍军人的睡眠， 功能和生活质量，同时以有效和可扩展的方式增加获得护理的机会。 意义/影响：取消处方和CBT-I都是定期提供的循证干预措施 然而，在VA内，可以简化护理和优化退伍军人结局的综合干预措施并不 随时可用。临床医生操作的辅助睡眠技术（COAST）是一种基于证据的数字化 睡眠平台，结合了在人CBT-I（个性化护理）的各个方面与远程医疗的好处（ 家庭护理，灵活的时间安排）。COAST的独特方法利用人工智能来开发量身定制的 建议，并将提供者的专业知识和个性化的取消处方整合在一个易于使用，高效， 和可扩展的包。拟议的干预措施有可能显著影响和改善退伍军人 健康和提供镇静催眠药开处方和CBT-I在VA。该提案与VA一致 RR&D将研究转化为临床实践的范围，以最大限度地提高退伍军人的功能 独立性、生活质量以及参与生活和社区。 创新性：这项试点研究务实而独特。目前还没有一项受资助的研究将联合收割机 通过COAST等可扩展且高效的数字平台交付。专注于睡眠 功能结果也将确保这种干预能够提高退伍军人的功能能力 和生活质量，以及减少临床症状和改善护理服务。 具体目标：目标1将评估招募长期使用镇静催眠药的退伍军人的可行性， 他们参与了通过数字健康平台提供的双重取消处方和失眠干预。 目标2将评估退伍军人对COAST平台的可接受性和可用性。目标3将评估 老年失眠症，镇静催眠药的使用，以及干预前后的临床和功能结局。 方法：这项为期12周的单组干预将招募并招募50名患有慢性镇静剂的退伍军人， 催眠药物的使用，减少这些药物的愿望，以及参与数字健康的能力 干预可行性将基于招募和参与。可接受性/可用性评估， 临床和功能结果将在基线、治疗后和治疗后3个月发生。 下一步：研究结果将用于为开发更大规模、具有适当把握度的临床试验提供信息， 测试COAST提供CBT-I和综合药剂师领导的处方的有效性，以改善 退伍军人睡眠和功能，并减少使用镇静催眠药物。此外，下一步将包括 努力更好地了解有助于或阻碍退伍军人使用数字干预的因素。未来 研究工作将涉及VA运营合作伙伴（例如，心理健康和自杀预防办公室， 远程医疗服务）和退伍军人咨询小组，以确保退伍军人和VA的需求得到满足。