Disrupted sleep architecture in adolescents with functional abdominal pain disorders

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Project Summary Functional abdominal pain disorders (FAPD) constitute one of the most common pediatric chronic pain conditions. FAPD is associated with significant disability, school absenteeism and suboptimal treatment outcomes. Treatment is hampered by an incomplete understanding of contributing factors like sleep disturbances. Subjective sleep disturbances have been reported in FAPD but the role of sleep architecture and its relationship to gastrointestinal (GI) symptoms has not been established. Preliminary data by the candidate has shown decreased slow wave sleep (%NREM3) measured via polysomnography (PSG) in FAPD patients vs. controls. Percutaneous Electrical Nerve Field Stimulation (PENFS) is an FDA cleared therapy for pediatric FAPD. Preliminary data indicates that PENFS improves sleep in addition to symptoms of FAPD. However, there is limited data on factors predicting response, effects on sleep architecture and underlying mechanisms. The primary aims of this K23 training application are to: (1) Determine the relationship of sleep architecture (NREM3 and other variables measured via PSG) with abdominal pain and other patient-reported outcomes in a case-control study of adolescents with FAPD. (2) Compare changes in sleep architecture before and after PENFS, associate with patient reported outcomes. This is the first study to objectively characterize sleep architecture in pediatric FAPD and changes with PENFS. Comprehensive measures of sleep physiology such as sleep questionnaires, daily diaries and actigraphy will be employed in addition to PSG to associate with GI measures. The primary objective is for the candidate to acquire advanced research training through a Master of Science in Clinical and Translational Research, learn sleep (PSG and actigraphy) and pain assessments, and advanced statistical methods. The long-term goal is to build an independent research program to study risk factors in pediatric FAPD and identify novel treatment targets to improve outcomes. The K23 candidate is an Assistant Professor of Pediatrics, and a pediatric gastroenterologist at Cincinnati Children's Hospital Medical Center (CCHMC). This application integrates a thoughtfully designed research and training plan developed in conjunction with mentors and collaborators who are leading scientists and clinical experts in pain, GI, sleep and behavioral medicine. CCHMC provides a rich collaborative research environment and is deeply dedicated to the development of young investigators with significant institutional funding opportunities, support in developing clinical trials, study monitoring, and statistical analysis through core resources at the Digestive Health Center, and Clinical Translation Research Center. This environment will be conducive to the candidate to complete the proposed research and training to achieve full research independence. Results will build the foundation for a subsequent R01 trial to further optimize PENFS outcomes and determine the relationship of central pain processing with NREM3 sleep.