Mechanisms Underlying the Relationship between Sleep Problems and Drug Use in Ado

描述（由申请方提供）：拟议的纵向R 01研究将阐明青少年睡眠问题与药物/酒精使用倾向之间关系的潜在机制。鉴于具有药物暴露前基线的前瞻性研究很少，并且缺乏综合模型，因此关于这种假定关系仍存在许多问题。一个系统的方法是必要的，检查内在的联系，时间动态和机制之间的关系，睡眠障碍和药物滥用。我们的综合，时间模型的理论，睡眠问题将是显着的预测药物/酒精的启动和升级的使用在青少年。我们进一步提出，这种关系可以解释至少部分由情绪失调，如测量的任务，招募情感边缘结构和扰动的神经内分泌（皮质醇）功能的认知功能水平，这是受睡眠问题和压力，并与情绪失调和药物滥用的风险，将缓和睡眠问题和药物使用之间的关系。长期暴露于压力（例如，虐待、忽视、离婚、贫穷），预计会放大中介关系，因为它已被证明会诱发情绪失调，扰乱睡眠，并影响药物滥用风险和复发。性别和青春期发育也将包括在这些模型中，因为研究结果表明，睡眠问题据报道比女孩更能预测男孩开始使用药物，而且两性的青春期发育与睡眠质量和持续时间较差有关。最后，该模型预测，最终的药物使用将加剧睡眠问题，并导致睡眠，情绪调节和认知的进一步减少，促进使用模式的升级。 我们有一个独特的机会来研究这些关系，通过访问参与者（529亲子二人组）在一个前所未有的正在进行的纵向，前瞻性研究药物使用（重点是大麻，青少年最常用的非法药物）使用在一个社区的使用率很高。基线数据是在10-12岁的青少年时收集的，最后一波数据收集工作即将完成，年龄在12-14.5岁之间。这项资助的研究旨在确定大麻使用相对于其他药物和非使用轨迹的神经认知前体和后果。这些儿童正在使用终生压力暴露、睡眠习惯和问题、智商、ECF、情绪调节、行为问题、精神障碍和药物/酒精使用（仅包括基线时的青少年药物和酒精）的测量进行评估。拟议的研究将延长数据收集两个额外的28个月波到青少年后期（直到~18-20岁），此时药物使用的途径变得越来越清楚，使用模式升级的过渡已经出现，使用的后果变得明显。为了检验提出的假设，我们将增加皮质醇采样，睡眠日志，睡眠活动记录，以及父母关于孩子睡眠模式的问题。如果儿童期的睡眠问题确实增加了药物使用和治疗棘手性的发病概率，那么父母、教师和临床医生对儿童和青少年睡眠问题的根本原因的更多关注将具有显著的预防和/或改善长期影响，因为这些功能具有可塑性。

DESCRIPTION (provided by applicant): The proposed longitudinal R01 study will elucidate mechanisms underlying the relationship between sleep problems and propensity to drug/alcohol use in adolescents. Many questions remain about this putative relationship given that prospective studies with a pre-drug exposure baseline are few and integrative models are lacking. A systems approach is needed that examines the inherent linkages, temporal dynamics, and mechanisms in the relationship between sleep disturbances and drug abuse. Our integrative, temporal model theorizes that sleep problems will be significant predictors of drug/alcohol initiation and escalation of use in adolescents. We propose further that this relationship can be explained at least in part by emotion dysregulation, as measured by tasks that recruit affective limbic structures and perturbations in neuroendocrine (cortisol) functioning Level of cognitive functioning, which is affected by sleep problems and stress and is associated with emotional dysregulation and risk for drug abuse, will moderate the relationship between sleep problems and drug use. Exposure to prolonged stress (e.g., maltreatment, neglect, divorce, poverty), is expected to amplify the mediational relationship because it has been shown to induce emotion dysregulation, disrupt sleep, and influence drug abuse risk and relapse. Gender and pubertal development also will be included in these models, given findings that sleep problems are reportedly more predictive of drug use initiation in boys than in girls, and that pubertal development in both sexes is associated with poorer sleep quality and duration. Finally, the model predicts that eventual drug use will exacerbate sleep problems and lead to further decrements in sleep, emotion regulation, and cognition, promoting an escalating pattern of use. We have a unique opportunity to study these relationships by accessing participants (529 parent-child dyads) in an unprecedented ongoing longitudinal, prospective study of drug use (with a focus on marijuana, the most commonly used illicit drug in adolescence) use in a community with a high prevalence of use. Baseline data were collected when youth were aged 10-12 and the last wave of data collection is near completion with youth between 12-14.5 years old. The funded study was designed to identify the neurocognitive precursors and consequences of marijuana use relative to other drug and nonuse trajectories. The children are being assessed using measures of lifetime stress exposures, sleep habits and problems, IQ, ECF, emotion regulation, behavioral problems, psychiatric disorders, and drug/alcohol use (only youth drug and alcohol nave at baseline were included). The proposed study would prolong data collection for two additional 28 month waves into later adolescent years (until ~18-20 years old) when pathways of drug use become increasingly clear, transitions to an escalated pattern of use have surfaced, and consequences of use become apparent. To test the proposed hypotheses, we will add cortisol sampling, sleep log, sleep actigraphy, and parent questions regarding the child's sleep patterns. If sleep problems in childhood indeed increase the probability of onset of drug use and treatment intractability, greater attention by parents, teachers, and clinicians to the underlying causes of sleep problems in children and adolescents would have significant preventive and/or ameliorative long-term implications given the malleability of these functions.