Targeting sleep homeostasis to improve alcohol use disorder treatment outcomes

以睡眠稳态为目标，改善酒精使用障碍的治疗结果

• 批准号: 10261433
• 负责人: J. Todd Arnedt
• 金额: $ 52.32万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-20 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10261433
• 关键词: Abstinence; Adult; Aftercare; Alcohol consumption; Alcohols; Cessation of life; Clinical; Cognitive Therapy; Cross-Sectional Studies; Education; Electroencephalography; Equipment and supply inventories; Evidence based treatment; Fatigue; Frequencies; Future; Homeostasis; Hygiene; Knowledge; Laboratories; Mediating; Medical Care Costs; Medical Economics; Michigan; Morbidity - disease rate; Outcome; Participant; Patients; Pharmaceutical Preparations; Polysomnography; Population; REM Sleep; Randomized; Randomized Controlled Trials; Relapse; Sampling; Severities; Sleep; Sleep Architecture; Sleep Disorders; Sleep disturbances; Sleeplessness; Slow-Wave Sleep; Symptoms; System; Telemedicine; Testing; Time; Treatment outcome; United States; Universities; Work; addiction; alcohol relapse; alcohol use disorder; base; comparative efficacy; deprivation; drinking; evidence base; follow-up; hypnotic; improved; improved outcome; indexing; innovation; mortality; non rapid eye movement; novel strategies; pilot trial; recruit; relapse prediction; social; treatment services

ABSTRACT Alcohol use disorder (AUD) is a leading preventable cause of morbidity and mortality in the United States. Evidence-based treatments exist, but relapse rates among adults with AUD remain unacceptably high. Novel approaches that target known predictors of relapse are therefore urgently needed. Insomnia during abstinence is highly prevalent, persistent, and independently predicts relapse in adults with AUD. Pilot randomized controlled trials by our group and others have shown that CBT for insomnia (CBTi) improves sleep and daytime symptoms among patients with AUD and insomnia, but its impact on drinking has not been adequately tested. Moreover, despite the identified associations between insomnia and relapse, the sleep mechanisms underlying this relationship are poorly understood. Prior work has identified significant abnormalities in a candidate mechanism among adults with AUD, sleep homeostasis, which is a key sleep regulatory system reflecting “sleep drive.” The objectives of this project, therefore, are to evaluate (a) the benefits of CBTi for sleep, drinking, and associated daytime symptoms and (b) the effects of CBTi on the homeostatic sleep system and its association with clinical outcomes in adults in AUD treatment with insomnia. One hundred and fifty adults entering AUD treatment at the University of Michigan Addiction Treatment Services with insomnia will be recruited and randomized to 6 weeks of either telemedicine-delivered CBTi (CBTi-TM, n=75) or Sleep Hygiene Education (SHE-TM, n=75). Drinking, sleep, and daytime symptom outcomes will be assessed pre- and post- treatment and at 3-, 6- and 12-month follow-up. Objective polysomnography will be conducted before and after treatment to assess homeostatic sleep drive. The specific aims of the study are: (1) to determine whether CBTi-TM improves insomnia and daytime symptoms more than SHE-TM in adults in AUD treatment with insomnia; (2) to compare the efficacy of CBTi-TM to SHE-TM on alcohol relapse; and (3) to compare the effects of CBTi-TM to SHE-TM on homeostatic sleep drive. Secondary aims will assess the extent to which changes in alcohol use are mediated by changes in the CBTi-TM (vs. SHE-TM) effects on the homeostatic sleep system. The findings from this trial have important implications for the future treatment of patients with AUD to support continued abstinence.

抽象的 酒精使用障碍（AUD）是美国发病率和死亡率的主要预防原因。 存在基于证据的治疗方法，但是具有AUD的成年人的继电器率仍然不可接受。小说 因此，迫切需要针对继电器的已知预测指标的方法。戒酒期间失眠 高度普遍，持久，并且独立预测AUD成人的继电器。飞行员随机 我们小组和其他人的对照试验表明，失眠（CBTI）的CBT改善了睡眠和白天 AUD和失眠患者的症状，但其对饮酒的影响尚未得到充分测试。 此外，策略失眠与退休之间的确定关联，睡眠机制 这种关系知之甚少。先前的工作已经确定了候选人的明显异常 成年人具有AUD，睡眠体内平衡的机制，这是反映的关键睡眠调节系统 “睡眠驱动。”因此，该项目的目标是评估（a）CBTI睡眠的好处， 饮酒和相关的白天症状以及（b）CBTI对体内稳态睡眠系统和 它与失眠的成年人的临床结局相关。一百五十名成年人 进入密歇根大学成瘾治疗服务的AUD治疗将是 招募并随机分配至6周的远程医疗递送的CBTI（CBTI-TM，n = 75）或睡眠卫生 教育（She-TM，n = 75）。饮酒，睡眠和白天的症状结局将在前和之后评估 治疗以及3个，6个月和12个月的随访。客观的多仪仪将在之前和之后进行 治疗以评估体内睡眠驱动器。该研究的具体目的是：（1）确定是否是否 CBTI-TM比成人在AUD治疗的成年人中改善失眠和白天符号 失眠; （2）将CBTI-TM与She-TM的饮酒效率进行比较； （3）比较 CBTI-TM对SHE-TM对稳态睡眠驱动器的影响。次要目标将评估在多大程度上 酒精使用的变化是由CBTI-TM（与SHE-TM）对体内平衡的影响的变化所介导的 睡眠系统。该试验的发现对未来患者的未来治疗具有重要意义 AUD支持持续的禁欲。