A Sleep Intervention to Improve Rehabilitation in Veterans with Chronic mTBI

睡眠干预可改善慢性 mTBI 退伍军人的康复

• 批准号: 10396972
• 负责人: Jonathan E Elliott
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10396972
• 关键词: Adverse effects; Chronic; Circadian Rhythm Sleep Disorders; Circadian Rhythms; Communities; Data; Development; Diffuse; Effectiveness; Excessive Daytime Sleepiness; Feasibility Studies; Future; General Population; Headache; Healthcare Systems; Home; Impairment; Individual; Intervention; Light; Literature; Measures; Meta-Analysis; Methods; Monitor; Nonpharmacologic Therapy; Outcome; Outcome Measure; Overdose; Pain; Pain Threshold; Pain intensity; Pain interference; Pain quality; Pathogenesis; Patient Self-Report; Persons; Pharmacology; Phototherapy; Population; Prevalence; Protocols documentation; Public Health; Publishing; Quality of life; Questionnaires; Randomized; Recording of previous events; Rehabilitation therapy; Reporting; Research; Severities; Sleep; Sleep disturbances; Sleeplessness; Testing; Time; Training; Traumatic Brain Injury; Treatment Effectiveness; United States National Institutes of Health; Veterans; Work; World Health Organization Disability Assessment Schedule; actigraphy; base; chronic pain; chronic pain management; conditioned pain modulation; cost effective; design; disability; economic impact; effective therapy; follow-up; functional disability; functional outcomes; improved; indexing; innovation; mild traumatic brain injury; military veteran; pain reduction; post intervention; prescription opioid addiction; pressure; prevent; primary outcome; recruit; rehabilitation strategy; rehabilitative care; sleep quality

Each year ~2.5 million people sustain a traumatic brain injury (TBI). Also a prominent general public health issue, TBI is particularly prevalent in Veterans, with 60-80% reporting a history of TBI. Over 80% of all TBI are categorized as mild TBI (mTBI), which is associated with a myriad of short- and long-term complications. Two of the principal complicating factors associated with mTBI are sleep-wake disturbances (e.g., insomnia, excessive daytime sleepiness, and circadian rhythm sleep disorders) and chronic pain, including headache and diffuse/global pain. Sleep-wake disturbances and chronic pain have an independent prevalence of ~70%, individually impair quality of life, impede effective rehabilitation, and have staggering economic impacts. Furthermore, there is a strong bidirectional relationship between sleep-wake disturbances and pain such that impaired sleep exacerbates pain, which leads to greater impairments in sleep and worse pain. This vicious cycle between sleep disturbances and pain, which is a particularly prevalent and detrimental condition in Veterans with chronic mTBI, represents a central challenge precluding effective treatment and ultimately, improving Veteran quality of life. Although there are pharmacological and non-pharmacological therapies for chronic pain, the presence of TBI significantly complicates the effectiveness of these treatment options, and have significant adverse effects (e.g., long-term prescription opioid dependence, misuse, and overdose). We believe there is profound potential to intervene at the sleep level, and, by improving sleep quality, enable Veterans with chronic mTBI to better manage their pain and end this vicious cycle. This proposal aims to apply a sleep intervention to improve chronic pain in Veterans with mTBI. We propose to use morning bright light therapy (MBLT), a readily deployable, cost-effective, non-pharmacologic, and home- based sleep intervention, to improve sleep-wake disturbances and therefore ameliorate chronic pain and improve quality of life in Veterans with chronic mTBI. There is substantial scientific precedent for MBLT to be effective in improving sleep quality, as outlined by a recent meta-analysis of 53 MBLT-based studies. Indeed, the potential of MBLT to improve sleep quality in Veterans with chronic mTBI remains unexplored, and yet, highly promising, especially in light of our exciting preliminary data supporting study feasibility and potential effectiveness. Our central hypothesis is that MBLT will improve sleep quality and ameliorate pain, resulting in improved quality of life in Veterans with chronic mTBI. Specific aims designed to test our hypothesis are to determine the effect of MBLT on, 1) sleep, 2) pain, and 3) quality of life, in Veterans with chronic mTBI. We propose to recruit n = 100 Veterans with mTBI from the VA Portland Health Care System, randomized 1:1 to MBLT (10,000 lux light exposure for 30 min within 90 min of waking for 4-weeks) or a no-light sham-MBLT condition (as previously published using the same duration/timing). Sleep quality will be assessed through self-report questionnaires and 24/7 actigraphy monitoring. Pain will be evaluated through self-report questionnaires and two quantitative methods (conditioned pain modulation and pressure algometry). Quality of life will be measured through self-report questionnaires. Outcomes will be assessed pre- and post-intervention, and at a 3-month follow-up time point. It is expected the proposed work will demonstrate MBLT is a viable method for improving sleep quality, ameliorating chronic pain and improving quality of life, in Veterans with mTBI. Improvements in pain and quality of life will positively correlate with objective markers of improved sleep quality. These data would demonstrate, 1) an effective treatment option, alone or in combination with existing rehabilitative efforts, in Veterans with mTBI, and 2) sleep-wake disturbances may be implicated in the pathogenesis of these functional impairments, thereby establishing greater precedent for targeting sleep as a meaningful primary and/or adjunctive rehabilitative therapy.

每年约有250万人遭受创伤性脑损伤（TBI）。还有一个突出的公共卫生问题