Heart rate variability as a modifiable biomarker of clinical symptoms and psychological functioning in pediatric patients with inflammatory bowel disease

心率变异性作为炎症性肠病儿科患者临床症状和心理功能的可修改生物标志物

• 批准号: 10722740
• 负责人: Bonney Reed
• 金额: $ 23.48万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10722740
• 关键词: Adolescent; Adult; Anxiety; Anxiety Disorders; Automobile Driving; Autonomic Dysfunction; Autonomic nervous system; Biofeedback; Biofeedback Training; Biological Markers; Cardiac; Central Nervous System; Child; Childhood; Chronic; Chronic Disease; Chronic stress; Clinical; Cognitive Therapy; Communication; Complex; Constipation; Coping Skills; Crohn' s disease; Data; Data Analyses; Depressive disorder; Diagnosis; Diarrhea; Disease; Distress; Elements; Emotional; Enrollment; Exhibits; Frequencies; Functional disorder; Gastrointestinal Diseases; Goals; Immune; Individual; Inflammatory Bowel Diseases; Intervention; Irritable Bowel Syndrome; Measurable; Measures; Mediating; Medical; Mental Depression; Modeling; Nervous System Physiology; Neurosecretory Systems; Normal Range; Outcome; Pain; Parasympathetic Nervous System; Patients; Pediatrics; Prediction of Response to Therapy; Process; Psychological Stress; Reporting; Research; Rest; Risk; Sampling; Source; Stress; Stress and Coping; Sympathetic Nervous System; Symptoms; Testing; Therapeutic Intervention; Time; Training; Treatment Efficacy; Treatment outcome; Ulcerative Colitis; Vomiting; Work; Youth; anxiety symptoms; biological adaptation to stress; clinical remission; clinically relevant; cognitive enhancement; depressive symptoms; efficacy testing; emotional distress; flexibility; follow-up; gastrointestinal; gut-brain axis; heart rate variability; hypothalamic-pituitary-adrenal axis; improved; indexing; intervention effect; pediatric patients; persistent symptom; primary outcome; programs; psychologic; psychological distress; psychosocial; technology training; treatment program; virtual

PROJECT SUMMARY Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are immune- mediated gastrointestinal disorders associated with chronic medical and psychosocial dysfunction. IBD is increasingly conceptualized as a product of the brain-gut axis, a model that describes the network of communication between the central nervous system (CNS), the autonomic nervous system (ANS), the hypothalamic-pituitary-adrenal (HPA) axis, and the gut. Consistent with a brain-gut axis model, patients with IBD demonstrate dysfunction of the ANS indicative of a chronic stress response. ANS functioning can be measured via heart rate variability (HRV), a non-invasive measure suitable for pediatrics. Early evidence suggests that patients with IBD exhibit alterations in HRV consistent with ANS rigidity as well as psychological distress and increased emotional reactivity to stress. These alterations in autonomic functioning are also observed in individuals with anxiety and depressive disorders, and it is well recognized that youth with IBD are at increased risk for developing chronic anxiety and depression. Biofeedback training to treat alterations in HRV has led to improvements in disease symptoms as well as reductions in emotional distress for youth with other chronic gastrointestinal illnesses. The goal of the proposed work is to test the utility of HRV as a biomarker of clinical symptoms as well as symptoms of anxiety and depression in pediatric patients with IBD who are enrolled in a biofeedback therapy program. In this R03 project, I will build on the work of my K23 (K23DK122115) to establish HRV as a clinically relevant and modifiable biomarker that can be reliably used in treatment studies of young patients with clinical symptoms of IBD and related stress, depression, and anxiety. I developed and am currently testing a remote HRV biofeedback-enhanced cognitive behavioral therapy (CBT) treatment program in 40 youth with IBD and symptoms of anxiety and depression. With R03 support we will be able to process the rich but complex raw HRV data obtained at baseline, during biofeedback sessions, and at posttest to evaluate the trajectory of HRV in these youth currently in treatment. The overall goals of the current study are to (1) determine the relationship between baseline HRV and clinical symptoms of IBD, anxiety, and depression in 40 adolescents with IBD and (2) determine if HRV changes with a virtual, biofeedback-enhanced CBT treatment intervention. This R03 offers a source of support for a new avenue of inquiry into HRV as a brain-gut axis mechanism driving chronic psychological distress and clinical symptoms in patients with pediatric IBD. Combined with the outcomes of the K23 research, findings will support a competitive R01 to test efficacy of a biofeedback-enhanced CBT intervention, using HRV as a primary outcome variable and biomarker of clinical improvement.

项目总结