Using Sleep Health to Optimize Smoking Cessation Treatment Response in HIV-Positive Adults

项目摘要 心血管疾病（CVD）是成人艾滋病毒感染者（ALHIV）发病和死亡的主要原因， 吸烟是这一人群中最重要的可改变的心血管疾病危险因素。成功率 现有的戒烟干预措施相对较少。睡眠不佳在吸烟者中更为普遍， 在ALHIV中流行，可能由戒烟尝试引起，预测复发到以前的吸烟 模式，并代表了一个平行的发病途径，包括增加心血管疾病（CVD） 在ALHIV。因此，不健康的睡眠可能会使戒烟更加困难，并增加心血管疾病 艾滋病风险和其他不良健康状况。然而，睡眠不佳可以通过非药物干预来改善， 我们小组的一项试点研究表明，睡眠健康干预可以提高戒烟率， 当添加到常规戒烟治疗。改善睡眠健康的机制 增强戒烟效果是未知的，但改善认知和情感功能是两个候选者。 评估我们的睡眠训练方法对改善睡眠健康和增加戒烟的效果 率ALHIV，拟议的研究将补充一个药物支持的戒烟计划（6- 会议，15周的咨询计划与伐尼克兰）与睡眠训练方法，以减少吸烟 （STARS）为吸烟者制定的干预措施。这种干预独特地解决了（1）现有的睡眠困难， 如果有，戒烟前可能与艾滋病毒状态或尼古丁使用有关;（2）接种预防未来睡眠 戒烟和/或伐尼克兰带来的困难;（3）急性干预睡眠效率和持续时间， 参与者通过该计划取得进展;以及（4）养成健康的睡眠习惯并继续下去 超越干预。这种方法是基于治疗失眠的金标准方法（认知 行为疗法的instruments），但包括一些新的元素，为这一人群量身定制。明星 将与一般健康（GH）教育对照进行比较。该研究将招募N=200名ALHIV吸烟者 有兴趣辞职的人他们将随机接受STARS（N=100）或GH戒烟 （N=100）。该研究将测量STARS与GH相比在改善客观测量的健康状况方面的疗效。 睡眠指标，评估其对戒烟的影响以及CVD风险的其他指标，并确定 认知和情感变量是否介导睡眠健康和戒烟之间的关联。 这些研究的结果将提供实用的信息，以及对睡眠健康如何机制的深入了解。 可用于优化ALHIV患者的戒烟治疗。

Project Summary Cardiovascular disease (CVD) is a major cause of morbidity and mortality in adults living with HIV (ALHIV), and cigarette smoking is the single most important modifiable CVD risk factor in this population. Success rates for existing smoking cessation interventions are relatively low. Poor sleep is more prevalent among smokers, more prevalent among ALHIV, can be caused by smoking cessation attempts, predicts relapse to former smoking patterns, and represents a parallel pathway to morbidity including increased cardiovascular disease (CVD) among ALHIV. Thus, unhealthy sleep may make smoking cessation more difficult and increase cardiovascular risk and other poor health conditions in ALHIV. Yet, poor sleep is amenable to nonpharmacologic interventions, and a pilot study from our group revealed that a sleep health intervention increased smoking cessation rates when added to routine smoking cessation treatment. The mechanisms by which improvements in sleep health enhance tobacco cessation are unknown, but improved cognitive and affective functioning are two candidates. To evaluate the efficacy of our sleep training approach to improve sleep health and increase smoking cessation rates in ALHIV, the proposed study will supplement an empirically-supported smoking cessation program (6- session, 15-week counseling program with varenicline) with a Sleep Training Approach to Reducing Smoking (STARS) intervention developed for smokers. This intervention uniquely addresses (1) existing sleep difficulties, if any, prior to quitting that may be associated with HIV status or nicotine use; (2) inoculation against future sleep difficulties brought on by quitting and/or varenicline; (3) acute intervention on sleep efficiency and duration as the participant progresses through the program; and (4) development of healthy sleep habits to carry forward beyond the intervention. This approach is based on the gold-standard approach to treating insomnia (Cognitive Behavioral Therapy for Insomnia) but includes a number of novel elements tailored to this population. STARS will be compared to a General Health (GH) educational control. The study will recruit N=200 ALHIV smokers who are interested in quitting. They will be randomized to smoking cessation with either STARS (N=100) or GH (N=100). The study will measure the efficacy of STARS versus GH to improve objectively measured healthy sleep metrics, assess its impact on smoking cessation as well as other metrics of CVD risk, and determine whether cognitive and affective variables mediate the association between sleep health and smoking cessation. Results of these studies will provide practical information as well as mechanistic insight into how sleep health can be leveraged to optimize smoking cessation treatment in ALHIV.