Longitudinal Study of Predisoposition and Life Events in Triggering Insomnia

描述（由申请人提供）：大多数失眠模型沿着诱发因素，推测个体易患失眠症。越来越多的证据表明，生活中的压力事件会导致失眠。然而，研究还没有确定失眠的特质倾向，或者调查压力暴露与这种倾向的相互作用。本研究的目的是前瞻性地确定睡眠反应的重要性（即，可靠地表现出响应于压力的睡眠中断的非失眠个体）在自然地暴露于压力性生活事件之后发展为慢性失眠。我们已经开发并验证了一种睡眠反应性的测量方法，该方法在正常个体中可预测1）对实验室压力源的多导睡眠描记睡眠障碍，2）在13个月的随访期内失眠的预期发展。假设没有失眠史的正常睡眠个体具有高的病前睡眠反应性将处于更大的风险中（即，易患）在暴露于压力性生活事件后发展为慢性失眠。将从2,200名没有失眠的人中收集关于他们在2年评估期内的压力生活事件和失眠发生率的前瞻性数据。假设这两个因素在预测失眠发生率方面具有大于加和的作用（即，暴露X易感性相互作用）。实验室测量的睡眠反应性在预测失眠发生率中的预测值也将在4年随访期内在随机选择的个体子集中确定。识别和跟踪可能发生失眠的个体将允许在疾病发生之前研究失眠的表型特征，改善我们对其时间过程及其与发病率的关系的有限理解，帮助识别特定的触发因素及其对高危人群的影响，并允许努力预防而不是治疗。公共卫生相关性：失眠是一种睡眠障碍，假设是由脆弱个体的压力引发的。目前的提案是一项为期2年的前瞻性研究，旨在验证以下假设："睡眠反应性"升高是暴露于压力性生活事件后发生慢性失眠的诱发风险因素。具体来说，我们假设压力和失眠的易感性之间的相互作用，即与非易感个体相比，具有易感性的个体在压力暴露下会有更高的疾病发生率。

DESCRIPTION (provided by applicant): Most models of insomnia hypothesize an individual predisposition to the disorder along with precipitating factors. Converging evidence suggests exposure to stressful life events can precipitate insomnia. However, research has yet to identify a trait predisposition to insomnia, or investigated the interaction of stress exposure with that predisposition. The purpose of this study is to prospectively determine the importance of sleep reactivity (i.e., non-insomniac individuals who reliably exhibit sleep disruption in response to stress) for the development of chronic insomnia following naturalistic exposure to stressful life events. We have developed and validated a measure of sleep reactivity that in normal individuals is predictive of 1) polysomnographic sleep disturbance in response to laboratory stressors and 2) the prospective development of insomnia over a 13-month follow-up period. It is hypothesized that normal sleeping individuals without a history of insomnia who have a high premorbid sleep reactivity will be at greater risk (i.e., predisposed) to developing chronic insomnia following exposure to stressful life events when compared to individuals with low sleep reactivity. Prospective data will be collected from 2,200 individuals without insomnia regarding their experiences of stressful life events and insomnia incidence during a 2-year assessment period. It is hypothesized that these two factors will have a greater than additive effect in predicting insomnia incidence (i.e., exposure X predisposition interaction). The predictive value of laboratory measured sleep reactivity in predicting insomnia incidence will also be determined in a randomly selected subset of individuals over a 4 year follow up period. Identifying and following individuals who are likely to develop insomnia will allow the study of phenotypic traits characteristic of insomnia prior to the development of the disorder, improve our limited understanding of its temporal course and its association with morbidity, help identify specific triggers and their impact in at-risk populations, and permit efforts to be directed toward prevention rather than treatment. PUBLIC HEALTH RELEVANCE: Insomnia is a sleep disorder hypothesized to be triggered by stress in vulnerable individuals. The current proposal is a 2 year prospective study testing the hypothesis that elevated "sleep reactivity" is a predisposing risk factor for the development of chronic insomnia following exposure to stressful life events. Specifically, we hypothesize an interaction between stress and the predisposition to insomnia whereby individuals with a predisposition will have a higher incidence of the disorder given stress exposure compared to non-predisposed individuals.