Sleep-Disordered Breathing and PAP in Perinatal Depression

 描述(由申请者提供)：这个以患者为导向的研究职业发展奖提出了一项量身定制的指导、重点研究、教学和课程作业计划，为候选人提供作为研究人员独立所必需的睡眠医学和围产期神经内分泌功能方面的培训。候选人。候选人在临床研究方面的背景和基础使她很有可能获得这一奖项。她在阿拉巴马大学完成了临床心理学博士学位，在那里她接受了植根于科学家-实践者模式的培训。她对睡眠和情绪产生了新的兴趣，这促使她在密歇根大学攻读博士后学位，在那里她开始在行为睡眠医学和围产期心理健康方面开拓了一个利基市场。她最近被任命为密歇根大学精神病学系的教员。她的目标是接受睡眠医学和围产期神经内分泌学方面的额外培训。这位候选人已经确定了作为一名研究人员实现完全独立所必需的两个关键培训目标：(1)睡眠生理学经验(包括对怀孕期间睡眠障碍呼吸的评估和治疗)和(2)怀孕期间的神经内分泌学。环境拟议的项目将在密歇根大学精神病学系和睡眠障碍中心内进行。这两个部门都有与妇产科密切合作的广泛历史。密歇根大学是美国第五大研究型大学，提供了广泛的资源和丰富的研究环境。应聘者将有权使用睡眠障碍中心内经过认证的大型睡眠实验室、妇女心理健康和婴儿计划(与产科部门合作)内成熟的围产期招募基础设施，以及由CTSA资助的密歇根临床与健康研究所提供的资源。被提名的首席导师罗纳德·切尔文是一位资金雄厚、工作效率高的睡眠障碍呼吸专家，他在睡眠医学领域有20多年的经验，在指导K奖获得者和初级教职员工方面有着悠久的历史。两位精心挑选的共同导师，生理学家路易丝·奥布莱恩博士和精神病学家胡安·洛佩兹医学博士，将分别提供围产期睡眠和神经内分泌学方面的重点培训。该提议还得到了一个量身定做的顾问团队的支持。研究。这项应用的目的是了解睡眠障碍呼吸(SDB)对围产期抑郁这一最常见和最令人衰弱的不良妊娠结局的影响。我们的假设是，对伴有抑郁的孕妇进行正压(PAP)的SDB治疗将显著减少抑郁症状并改善神经内分泌功能。这项建议将利用我们在妊娠和不良妊娠结局(包括围产期抑郁)的PAP方面的独特专业知识。其基本原理是，更好地了解SDB的作用和PAP治疗对围产期抑郁症的影响，将允许开发有针对性的、关键时机的干预措施，这可能对妇女及其后代都有长期好处。我们计划通过随机分配50名患有SDB的女性来检验我们的假设，这些女性要么接受正压治疗(PAP组)，要么接受产科常规治疗(非PAP组)。将测试以下具体目标：目的1：确定PAP治疗对患有SDB和抑郁症的孕妇产前抑郁症状的影响。目的：探讨PAP治疗对妊娠高血压综合征合并抑郁症孕妇HPA轴的影响。一个探索性的目的是评估抑郁症和SDB妇女的PAP治疗与不良妊娠和新生儿结局之间的关系。关于预期结果，拟议的工作将证明孕期SDB在围产期抑郁中发挥作用，妊娠期SDB治疗将改善抑郁症状和HPA轴功能，并改善妊娠和新生儿结局。这些发现有望产生重要的积极影响，因为它们将加深我们对SDB在不良妊娠结局中的作用的理解，并减轻孕妇经历的最常见和令人衰弱的不良结局的负担。这将对妇女及其后代的健康产生长期的好处。总结。拟议的K23将为一名有前途的早期研究员提供关键的额外培训，使其成为围产期睡眠医学的临床研究人员。该项目还将解决重要的、可测试的问题，即常见的睡眠障碍与围产期抑郁症导致的令人衰弱的不良妊娠结局之间的关系，这是一个主要的公共卫生问题。

 DESCRIPTION (provided by applicant): This Mentored Patient-Oriented Research Career Development Award proposes a program of tailored mentorship, focused research, didactics and coursework to provide the candidate with the training in sleep medicine and perinatal neuroendocrine functioning necessary for independence as an investigator. Candidate. The candidate's background and foundation in clinical research make her well-poised for this award. She completed her Ph.D. in clinical psychology at the University of Alabama, where she received training rooted in the scientist-practitioner model. An emerging interest in sleep and mood led her to pursue a postdoctoral fellowship at the University of Michigan, where she began to develop a niche in behavioral sleep medicine and perinatal mental health. She was recently appointed to the faculty of the Department of Psychiatry at the University of Michigan. Her goal is to receive additional training in sleep medicine and perinatal neuroendocrinology. The candidate has identified two key training objectives necessary to achieve full independence as a researcher: (1) experience in sleep physiology (including assessment and treatment of sleep-disordered breathing in pregnancy) and (2) neuroendocrinology in pregnancy. Environment. The proposed project will take place within the University of Michigan Department of Psychiatry and the Sleep Disorders Center. Both departments have an extensive history of close collaboration with the Department of Obstetrics and Gynecology. The fifth largest research university in the United States, the University of Michigan provides extensive resources and a rich research environment. The candidate will have access to the large, accredited Sleep Laboratory within the Sleep Disorders Center, the well-established perinatal recruitment infrastructure within the Women's Mental Health and Infants Program (in collaboration with the Department of Obstetrics), and resources provided by the CTSA-funded Michigan Institute for Clinical and Health Research. The proposed primary mentor, Ronald Chervin, M.D., M.S., is a well-funded, highly productive expert in sleep-disordered breathing who has more than 20 years of experience in sleep medicine and a long history of mentoring K awardees and junior faculty. Two carefully selected co-mentors, physiologist Louise O'Brien, Ph.D., M.S., and psychiatrist Juan Lopez, M.D., will provide focused training in perinatal sleep and neuroendocrinology, respectively. The proposal is also bolstered by a tailored consultant team. Research. The goal of this application is to understand the contribution of sleep-disordered breathing (SDB) to one of the most common and debilitating adverse pregnancy outcomes, perinatal depression. It is our hypothesis that positive airway pressure (PAP) treatment of SDB in pregnant women with comorbid depression will result in significant reductions in depressive symptoms and improved neuroendocrine functioning. This proposal will leverage our unique expertise with PAP for SDB in pregnancy and adverse pregnancy outcomes, including perinatal depression. The rationale is that a better understanding of the role of SDB and the impact of PAP treatment on perinatal depression will allow for development of targeted and critically-timed interventions which may have long-term benefits for both women and their offspring. We plan to test our hypothesis by randomly assigning 50 women with SDB to receive either positive airway pressure treatment (PAP group) or treatment as usual in obstetrics (non-PAP group). The following specific aims will be tested: AIM 1: Determine the impact of PAP treatment on prenatal depressive symptoms in pregnant women with SDB and depression. AIM 2: Identify the contribution of PAP treatment on the HPA axis in pregnant women with SDB and depression. An exploratory aim is to assess associations between PAP treatment and adverse pregnancy and neonatal outcomes in women with depression and SDB. With respect to expected outcomes, the proposed work will demonstrate that SDB during pregnancy plays a role in perinatal depression, and that treatment of SDB during pregnancy will ameliorate depressive symptoms and HPA axis functioning, and improve pregnancy and neonatal outcomes. Such findings are expected to have an important positive impact, because they will further our understanding of the role of SDB in adverse pregnancy outcomes and reduce the burden of the most common and debilitating adverse outcomes experienced by pregnant women. This will have long term health benefits for both women and their offspring. Summary. The proposed K23 will provide key additional training for a promising early investigator to become a clinical researcher in perinatal sleep medicine. The project will also address important, testable questions about the relationships between a common sleep disorder and the debilitating adverse pregnancy outcome of perinatal depression, a major public health concern.