Positive and negative reinforcement pathways underlying sleep and alcohol use associations

项目摘要 意义：睡眠障碍与酒精使用（Au）和酒精问题增加有关。的 解释这种关联的机制尚不清楚。这项拟议的研究将是第一个 检查包括正强化途径（即，更高的冲动性， 对酒精刺激作用的敏感性增加）和负强化途径（即，更高 焦虑和对酒精抗焦虑作用的敏感性增加），这可能与睡眠障碍和 酒精问题。我们将使用严格的多方法方法，将实验室扩展到真实的世界。 通过确定哪些特定的睡眠因素导致风险以及原因，结果可以直接告知Au治疗。 目的：对于正强化途径，我们假设晚睡和短睡 持续时间将预测更高的冲动性和更大的增加冲动性和刺激，而陶醉。为 负强化途径，我们假设睡眠效率降低，失眠的标志， 预测清醒时更高的焦虑和对酒精的抗焦虑反应增加。这些过程将说明 睡眠因素与同期和前瞻性Au结局之间的关联。特异性 积极和消极的强化途径将被检查。我们还将探讨性别或诊断状态 （酒精使用障碍（AUD），睡眠障碍）调节睡眠特征和 增强途径的Au。方法：年轻成年饮酒者（21-30岁; 50%女性; N = 150） 将完成一项包括生态瞬时评估（EMA）、实验室睡眠和酒精的方案 反应评估和6个月随访。参与者将是目前的重度间歇性饮酒者（即，5岁以上 男性/女性在过去30天内饮用5+/4+的天数; SAMHSA），以确保酒精含量足够 利益的结果。我们将使用两个为期10天的EMA/体动记录方案来跟踪日常睡眠特征 （时间，持续时间和效率），焦虑，Au（5+/4+饮料/场合的频率），冲动和主观 在真实的世界中的酒精反应。每个EMA方案将以过夜睡眠实验室结束 评估后进行受试者内实验室酒精给药（平衡：安慰剂/酒精 （二）检查酒精反应。在时间生物学实验室访视期间，我们将使用唾液DLMO， 评估生理昼夜节律。在酒精实验室访问期间，我们将测量阳性和阴性 通过主观反应（刺激/焦虑）和冲动（自我报告，任务）的强化途径。一个90- 6个月后进行的为期一天的时间轴随访访谈将允许前瞻性检查 睡眠特征与后来的Au（5+/4+饮料/场合的频率）和问题之间的关联。的 一项拟议的研究将提供关于睡眠障碍如何影响的新信息，一组可改变的因素， 酒精反应和冲动这些发现可能直接转化为AUD的预防/治疗工作。

PROJECT SUMMARY Significance: Sleep disturbances are related to increased alcohol use (AU) and alcohol problems. The mechanisms that account for this association are not well understood. The proposed study will be the first to examine an integrative model including both a positive reinforcement pathway (i.e., higher impulsivity and increased sensitivity to the stimulating effects of alcohol) and a negative reinforcement pathway (i.e., higher anxiety and increased sensitivity to the anxiolytic effects of alcohol) that may link sleep disturbances and alcohol problems. We will use a rigorous multi-method approach that extends the laboratory into the real world. Results may directly inform AU treatment by identifying which specific sleep factors contribute to risk and why. Aims: For the positive reinforcement pathway, we hypothesize that later sleep timing and shorter sleep duration will predict higher impulsivity and greater increases in impulsivity and stimulation while intoxicated. For the negative reinforcement pathway, we hypothesize that lower sleep efficiency, a marker of insomnia, will predict higher anxiety while sober and increased anxiolytic response to alcohol. These processes will account for the association between sleep factors and concurrent and prospective AU outcomes. Specificity of the positive and negative reinforcement pathways will be examined. We will also explore if sex or diagnostic status (alcohol use disorder (AUD), sleep disorders) moderate the relationships between sleep characteristics and reinforcement pathways to AU. Approach: Young adult drinkers (21-30 years of age; 50% female; N = 150) will complete a protocol that includes ecological momentary assessments (EMA), laboratory sleep and alcohol response assessments, and 6-month follow-up. Participants will be current heavy episodic drinkers (i.e., 5+ days in past 30 days of consuming 5+/4+ for males/females; SAMHSA) to ensure sufficient range in alcohol outcomes of interest. We will use two 10-day EMA/actigraphy protocols to track daily sleep characteristics (timing, duration, and efficiency), anxiety, AU (freq. of 5+/4+ drinks/occasion), impulsivity, and subjective alcohol response in the real world. Each EMA protocol will conclude with an overnight sleep laboratory assessment followed by a within-subjects laboratory alcohol administration (counterbalanced: placebo/alcohol sessions) to examine alcohol response. During the chronobiology lab visits, we will use salivary DLMO to assess physiological circadian timing. During the alcohol lab visits, we will measure positive and negative reinforcement pathways via subjective response (stimulation/anxiety) and impulsivity (self-report, tasks). A 90- day timeline follow-back interview delivered 6 months later will allow for the prospective examination of associations between sleep characteristics and later AU (freq. of 5+/4+ drinks/occasion) and problems. The proposed study will provide novel information about how sleep disturbances, a set of modifiable factors, affect alcohol response and impulsivity. These findings may directly translate to prevention/treatment efforts for AUD.