Mechanisms of Sleep Disturbance in Children with Generalized Anxiety Disorder

描述(由申请人提供)：这是第二次重新提交以患者为导向的导师研究职业发展奖(K23)的申请，以支持申请人的学术生涯发展。这位候选人的长期目标是开发一项与临床相关的转化性研究计划，重点是检查睡眠障碍在儿童焦虑症的过程和治疗中的影响和可调性。此前，申请人曾就儿童和青少年焦虑症的发展进行过研究，包括睡眠障碍的患病率。本申请提出了这项研究计划下一步所需的培训，包括儿科睡眠医学的高级培训，多导睡眠图的使用和解释的基于实验室的培训，焦虑儿童唤醒的神经激素维度的评估，以及研究伦理和进一步的培训 方法论。对一组精选的高级调查人员的指导将培养候选人的 一个前景看好的新研究领域的发展，整合了两个不同的研究领域：睡眠 医学和发展精神病理学。先前的研究表明，90%以上患有广泛性焦虑症(GAD)的儿童在启动和/或维持睡眠方面遇到问题；这一比例与患有这种疾病的成年人相似或更高。由于儿童时期持续的睡眠障碍与多种功能障碍独立相关，包括学习失败、情绪调节能力下降、注意力和推理能力下降、受伤风险和冒险行为，GAD儿童的睡眠问题可能会加剧现有的障碍，加剧焦虑症状，并导致较低的康复和较高的复发率。这项拟议的研究将使用严格的评估方法来解决两个主要目标：1)基于为期一周的前瞻性家庭评估，与一组匹配的对照组比较，评估广泛性焦虑症儿童睡眠障碍的持续性、特征和日间后遗症；以及2)确定与广泛性焦虑症儿童存在睡眠问题相关的具体因素，这些因素涉及唤醒的神经生理和认知维度，以及父母教养和环境因素。本提案中概述的培训和研究将使候选人具备一套独特的必要技能，以增进这一重要且研究不足的领域的知识。从长远来看，数据将为同时患有睡眠和焦虑症的儿童制定基于经验的干预措施提供信息。

DESCRIPTION (provided by applicant): This is the second resubmission of an application for a Mentored Patient-Oriented Research Career Development Award (K23) to support the academic career development of the applicant. The candidate's long term goal is to develop a program of clinically-relevant, translational research focused on examining the influence and modifiability of sleep disturbance in the course and treatment of childhood anxiety disorders. Previously, the applicant has conducted research focused on the development of anxiety disorders in children and adolescents, including the prevalence of sleep disturbance. This application proposes training that is necessary for the next step in this research program, including advanced training in pediatric sleep medicine, laboratory-based training in the use and interpretation of polysomnography, assessment of neurohormonal dimensions of arousal in anxious children, and further training in research ethics and methodology. The mentorship of a select group of senior investigators will foster the candidate's development in a promising new area of research integrating two distinct areas of investigation: sleep medicine and developmental psychopathology. Prior research indicates that more than 90% of children with Generalized Anxiety Disorder (GAD) experience problems initiating and/or maintaining sleep; rates that are similar or higher than those found among adults with the disorder. Because persistent sleep disturbance during childhood is independently associated with multiple impairments in functioning including academic failure, decreased emotion regulation, decrements in attention and reasoning skills, injury risk, and risk-taking behavior, sleep problems among children with GAD may compound existing impairments, exacerbate anxiety symptoms, and result in lower recovery and higher relapse rates. The proposed study will use rigorous methods of assessment to address two primary aims: 1) to evaluate the persistence, features and daytime sequelae of sleep disturbance in children with GAD compared to a group of matched controls based on a one-week prospective, at-home assessment; and 2) to identify specific factors associated with the presence of sleep problems among children with GAD related to neurophysiologic and cognitive dimensions of arousal, and parenting and environmental factors. The training and research outlined in this proposal will equip the candidate with a unique set of necessary skills to advance knowledge in this important and under-researched area. Over the long-term, data will inform the development of empirically-based interventions for children with both sleep and anxiety disorders.