Sleep Disturbance in Rheumatoid Arthritis: Phenotypes, Causes, and Impact

类风湿性关节炎的睡眠障碍：表型、原因和影响

• 批准号: 10237308
• 负责人: Patricia P Katz
• 金额: $ 59.47万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10237308
• 关键词: Address; Affect; Arthritis; Attention; Biological; Biological Markers; Blood; Circadian Dysregulation; Circadian Rhythms; Classification; Clinical; Cognitive; Collaborations; Collection; Data; Development; Disease; Enrollment; Evaluation; Excessive Daytime Sleepiness; Fatigue; Glucocorticoids; Goals; Health; Health Status; High Prevalence; Home; Hormonal; Hour; Hydrocortisone; Immune; Immunology; Impairment; Individual; Inflammation; Inflammatory; Interleukin-6; Intervention; Knowledge; Lead; Link; Longitudinal Studies; Measures; Mediator of activation protein; Mental Depression; Methods; Modeling; Monitor; Neurosecretory Systems; Outcome; Output; Pain; Pain Threshold; Pathway interactions; Patient Self-Report; Patients; Pattern; Persons; Pharmaceutical Preparations; Phenotype; Physical Function; Physical activity; Polysomnography; Population; Prevalence; Prevention; Process; Proteins; Psychoneuroimmunology; Quality of life; Questionnaires; Regulation; Reporting; Research; Research Personnel; Rest; Rheumatoid Arthritis; Rheumatology; Risk; Risk Factors; Role; Salivary; Sampling; Severities; Sleep; Sleep Disorders; Sleep disturbances; Statistical Methods; Symptoms; Telephone; Testing; Therapeutic; Variant; actigraphy; analytical method; arthritic pain; arthritis therapy; base; circadian; cognitive function; cohort; comorbidity; depressive symptoms; design; diaries; dosage; evidence base; falls; follow-up; immune function; improved; inflammatory marker; innovation; insight; new technology; novel; novel therapeutic intervention; prospective; response; screening; sleep quality; systemic inflammatory response

Project Summary/Abstract Self-reported sleep problems are common in rheumatoid arthritis (RA), but objectively-measured data on sleep are lacking. Our preliminary data provide evidence of frequent self-reported sleep problems, existence of objectively-identified sleep disturbances, and the association of those sleep disturbances with poor RA-specific health outcomes. The proposed project will address the significant knowledge gaps surrounding sleep disturbances in RA. Project aims are to: (1) identify risk factors associated with sleep disturbance and changes in sleep disturbance in individuals with RA; (2) identify the short-term and longer-term longitudinal effects of sleep disturbance and changes in sleep disturbances on health outcomes in RA; and (3) examine a biological pathway unique to RA to explain the high prevalence of sleep disturbance in RA and associations with RA outcomes. No previous studies have attempted to link the disruptions in inflammatory biomarkers and cortisol, and the concomitant peaking of RA symptoms, with sleep disturbance or with disruption of circadian rest- activity patterns. 150 individuals with RA will be enrolled and followed over 24 months. Baseline, 6- and 12- month assessments will consist of 7-nights of actigraphy monitoring to measure sleep and circadian rest- activity patterns; completion of sleep and symptom diaries; questionnaires to assess disease activity, pain, fatigue, physical activity, and symptoms of depression; blood draws for inflammatory markers; and salivary diurnal cortisol collection. Screening for other primary sleep disorders will be conducted at baseline. Follow-ups 18 and 24 months after baseline will continue monitoring sleep and outcomes with 7 nights of sleep monitoring by actigraphy and completion of sleep/symptom diaries and questionnaires. Bi-weekly telephone check-ins will be conducted to monitor use, dosage, and timing of glucocorticoids (GCs) and other medications. Innovative components of the proposed project include objective measurements of sleep, detailed examination of the role of GCs in sleep disturbance in RA, examination of the roles of inflammatory and hormonal biomarkers, and the extended longitudinal assessments, which will permit examination of the potential reciprocal effects of sleep disturbance, inflammation, circadian variation in cortisol, and RA symptoms and disease activity. The study team includes a unique collaboration of investigators with expertise in rheumatology, sleep, immunology, psychoneuroimmunology, and statistical methods. Data will yield insights into predictors and mechanistic precursors of sleep disturbance, provide information regarding the impact of sleep disturbance on RA health outcomes, and provide preliminary evidence for potential interventions. Understanding sleep disturbances in RA is important because assessments of RA disease activity, as well as decisions on the use, timing and evaluation of response to RA therapy, may be impacted by concurrent sleep problems. Better understanding of sleep disturbances in RA may lay groundwork for design and conduct of studies to improve therapeutic strategies, which will ultimately improve health and quality of life of persons with RA.

项目总结/摘要 自我报告的睡眠问题在类风湿性关节炎（RA）中很常见，但客观测量的数据显示， 睡眠不足。我们的初步数据提供了频繁自我报告睡眠问题的证据， 客观确定的睡眠障碍，以及这些睡眠障碍与RA特异性 健康成果。拟议的项目将解决围绕睡眠的重大知识差距 在RA的干扰。项目的目的是：（1）识别与睡眠障碍和变化相关的危险因素 在睡眠障碍的个人与类风湿关节炎;（2）确定短期和长期的纵向影响， 睡眠障碍和睡眠障碍的变化对RA健康结果的影响;（3）检查生物学 RA特有的通路，以解释RA中睡眠障碍的高患病率及其与RA的相关性 结果。以前没有研究试图将炎症生物标志物和皮质醇的破坏联系起来， 以及伴随的RA症状峰值，伴睡眠障碍或昼夜节律休息中断- 活动模式。将入组150名RA患者，并随访24个月。基线，6岁和12岁 一个月的评估将包括7个晚上的活动监测，以测量睡眠和昼夜休息- 活动模式;完成睡眠和症状日记;评估疾病活动，疼痛， 疲劳、体力活动和抑郁症状;抽血检查炎症标志物;唾液 昼夜皮质醇收集。将在基线时进行其他原发性睡眠障碍的筛查。随访 基线后18个月和24个月，将继续监测睡眠和结局，监测7晚睡眠 通过体动记录仪和完成睡眠/症状日记和调查问卷。每两周一次的电话报到将 进行监测糖皮质激素（GC）和其他药物的使用，剂量和时间。创新 拟议项目的组成部分包括睡眠的客观测量， GC在RA睡眠障碍中的作用，检查炎症和激素生物标志物的作用， 扩展的纵向评估，这将允许检查睡眠的潜在相互影响 紊乱、炎症、皮质醇的昼夜变化以及RA症状和疾病活动。研究 团队包括一个独特的合作研究人员与专业知识在风湿病学，睡眠，免疫学， 心理神经免疫学和统计学方法。数据将产生对预测因素和机制的见解 睡眠障碍的前兆，提供有关睡眠障碍对RA健康影响的信息 结果，并为潜在的干预措施提供初步证据。了解睡眠障碍 RA是重要的，因为RA疾病活动的评估，以及关于使用，时机和 评估对RA治疗的反应，可能会受到并发睡眠问题的影响。更好地了解 类风湿性关节炎睡眠障碍可能为设计和进行研究以改善治疗奠定基础 这些战略将最终改善类风湿关节炎患者的健康和生活质量。