Sleep deficiency and opioid use/misuse in adolescents following surgery

青少年术后睡眠不足和阿片类药物使用/滥用

• 批准号: 10734732
• 负责人: Cornelius Botha Groenewald
• 金额: $ 64.14万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-10 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10734732
• 关键词: Acute; Acute pain management; Address; Adolescent; Adolescent Development; Affect; Athletic Injuries; Behavior; Behavior Therapy; Behavioral; Behavioral Mechanisms; Clinical Trials; Data; Development; Dose; Ecological momentary assessment; Electronics; Exposure to; Family; Future; Intervention; Knowledge; Measures; Mediating; Mediation; Medical; Mental Depression; Methodology; Methods; Modernization; Monitor; Moods; Observational Study; Operative Surgical Procedures; Opioid; Orthopedic Surgery; Overdose; Pain; Pain intensity; Pain management; Participant; Pathway interactions; Patient Self-Report; Perioperative; Pharmaceutical Preparations; Pilot Projects; Prevention; Process; Psychological Factors; Public Health; Recording of previous events; Reporting; Research; Risk; Risk Factors; Sleep; Sleep Deprivation; Sleep Disorders; Surgical Injuries; Surveys; Technology; Testing; Time; United States; Youth; actigraphy; adolescent patient; critical period; follow up assessment; innovation; machine learning algorithm; modifiable risk; multimodality; novel; opioid epidemic; opioid misuse; opioid use; opioid use disorder; peer; poor sleep; predictive modeling; prescription opioid; prescription opioid misuse; prospective; psychologic; psychological symptom; psychosocial; public health relevance; response; sleep quality; substance use; therapeutic target

PROJECT SUMMARY Prescription opioid misuse is a significant burden on adolescent public health in the United States. Opioid misuse often starts with prescribed opioids, with surgery representing a key pathway by which adolescents are first prescribed opioids for the management of acute pain. Yet, little is known about the critical period following surgery during which adolescents initiate prescription opioid misuse or the modifiable behavioral mechanisms contributing to this process. These are critical gaps in our knowledge impeding our ability to identify adolescents at increased risk for opioid misuse and to develop interventions aimed at reducing prescription opioid misuse. Sleep deficiency (including sleep deprivation, noncircadian sleep, sleep disorders, and poor sleep quality) is an important proximal risk factor for prescription opioid misuse. Sleep is often disturbed during the perioperative period, a time when many adolescents are exposed to their first opioid prescription. Indeed, in our own preliminary study, we found that sleep deficiency present both before surgery and during the immediate postsurgical period was associated with increased opioid use. However, this pilot study did not allow us to characterize aspects of sleep most strongly related to opioid use and did not allow us to evaluate mechanisms, such as pain and psychological factors, underlying the sleep – opioid use relationship. Furthermore, data are urgently needed to determine how sleep deficiency prospectively predicts the development of opioid misuse behaviors in the context of other putative factors, such as a history of substance use, pain intensity, psychosocial (e.g., depression), peer, and family factors. Given that sleep deficiency is modifiable, it is a critical focus of research aimed at reducing the development of adolescent opioid misuse behaviors. Therefore, this project aims to 1) test the direct and mediation pathways of sleep deficiency, pain, psychological factors, and opioid use following sports-injury surgery, and 2) develop and validate a multivariable prediction model to identify adolescents at increased risk of prescription opioid misuse over the 24 months following surgery. To address these aims, we propose a prospective, observational study of N= 400 adolescents (10-19 years) who receive their first ever opioid following sports injury surgery. Presurgery, participants will undergo comprehensive multimodal sleep assessments (surveys and actigraphy monitoring) to measure sleep deficiency. Participants will also report on previous substance use, pain intensity, psychosocial, peer, and family factors. Adolescents will then be followed over the first 14 days after surgery using ecological momentary assessment to capture real-time daily data on sleep, pain, psychological factors, and opioid use. We will use an innovative electronic medication monitoring methodology to accurately measure opioid use (total number of doses and duration) following surgery. Follow-up assessments at 3-months, 6-months, 12- months, and 24-months will track opioid misuse developing over time. We will apply modern machine learning algorithms to develop and validate models predicting adolescent prescription opioid misuse.

项目摘要 处方阿片类药物滥用是美国青少年公共卫生的重大负担。阿片 滥用通常始于处方阿片类药物，手术是青少年被滥用的关键途径。 第一次开阿片类药物治疗急性疼痛。然而，人们对以下关键时期知之甚少： 青少年开始滥用处方阿片类药物或可改变的行为机制的手术 为这一进程做出贡献。这些是我们知识中的关键空白，阻碍了我们识别 阿片类药物滥用风险增加的青少年，并制定旨在减少处方的干预措施， 阿片类药物滥用睡眠不足（包括睡眠剥夺、非昼夜节律睡眠、睡眠障碍和睡眠质量差） 睡眠质量）是处方阿片类药物滥用的重要近端风险因素。睡眠经常受到干扰， 围手术期，许多青少年首次接触阿片类药物处方的时间。的确， 在我们自己的初步研究中，我们发现在手术前和手术期间都存在睡眠不足， 术后即刻与阿片类药物使用的增加有关。然而，这项试点研究没有 使我们能够描述与阿片类药物使用最密切相关的睡眠方面，但不允许我们评估 机制，如疼痛和心理因素，潜在的睡眠-阿片类药物使用的关系。 此外，迫切需要数据来确定睡眠不足如何前瞻性地预测 在其他假定因素的背景下发展阿片类药物滥用行为，例如物质史 使用、疼痛强度、社会心理（例如，抑郁症），同伴和家庭因素。鉴于睡眠不足是 它是一个关键的研究重点，旨在减少青少年阿片类药物滥用的发展 行为。因此，本项目旨在1）测试睡眠不足，疼痛， 心理因素和运动损伤手术后阿片类药物的使用，以及2）开发和验证 多变量预测模型，以确定青少年在处方阿片类药物滥用的风险增加， 手术后24个月。为了实现这些目标，我们提出了一项N= 400的前瞻性观察性研究 青少年（10-19岁）在运动损伤手术后首次接受阿片类药物治疗。手术前， 参与者将接受全面的多模式睡眠评估（调查和活动监测）， 测量睡眠不足。参与者还将报告以前的物质使用，疼痛强度，心理社会， 同伴和家庭因素。青少年将在手术后的前14天内使用生态学方法进行随访。 即时评估，以捕获有关睡眠，疼痛，心理因素和阿片类药物使用的实时日常数据。 我们将使用创新的电子药物监测方法来准确测量阿片类药物的使用情况 （总剂量和持续时间）。3个月、6个月、12个月和14个月时的随访评估 个月和24个月将跟踪阿片类药物滥用随着时间的推移而发展。我们将应用现代机器学习 算法开发和验证预测青少年处方阿片类药物滥用的模型。