Sleep deficiency and autonomic function in pediatric chronic abdominal pain

项目摘要/摘要 儿童慢性腹痛非常普遍，并与明显较差的身体和 心理社会功能，以及更多的旷课。此外，这些儿童患癌症的风险更大 成为患有慢性腹痛、重叠疼痛综合征和心理社会功能障碍的成年人。 慢性疼痛已经成为一种公共卫生危机，每年的成本超过6000亿美元。目前， 慢性腹痛的潜在机制尚不清楚，限制了 干预措施。现在有令人信服的证据表明，睡眠不足可能是疼痛发展的先兆。 此外，睡眠不足与自主神经功能障碍和情感障碍相关，这些通常是 由慢性腹痛患者报告，突出了共同的中枢神经生物学过程。 了解睡眠不足作为慢性腹痛的潜在机制的作用将会扩大 治疗的途径。这项研究计划的长期目标是开发新的中断策略 慢性腹痛的轨迹。本申请的目的是阐明纵向的 睡眠不足对青少年腹痛病程的影响 自主神经和心理在这种关系中的作用。K23候选人是一名助理教授 华盛顿大学麻醉学和疼痛医学系和一名儿科疼痛 西雅图儿童医院的内科医生和麻醉师。这份提案概述了一项综合良好的研究 和培训计划，由一个跨学科团队支持，以指导、以患者为导向的职业发展 具有青少年发展、心理生理学研究、纵向建模和 临床研究应用。该奖项将为候选人提供关于以下方面的专门指导 儿科腹痛人群的睡眠和心脏生理生物标记物的评估和专业性 在进行纵向研究时。中心目标是比较睡眠不足、疼痛处理、 青少年慢性腹痛患者的自主神经和心理功能与健康对照 青少年(研究1)；并评估青少年的这些纵向轨迹和相互关系 6个月以上患有慢性腹痛的青少年与健康青少年的比较(研究2)。评估将 包括对疼痛、自主神经和心理功能主观评估 睡眠模式的动态监测将与心理生理疼痛的实验室评估相结合 任务和心率变异性。此研究生成的数据将直接为计划中的R01提案提供信息 开发针对睡眠不足和自主神经功能的量身定制的干预措施，作为可改变的风险因素 治疗。完成拟议的培训将为成功的独立候选人做好准备 儿科慢性腹痛医学研究生涯。

Project Summary/Abstract Childhood chronic abdominal pain is highly prevalent, and associated with significantly poorer physical and psychosocial functioning, and increased school absenteeism. Moreover, these children are at a greater risk of becoming adults with chronic abdominal pain, overlapping pain syndromes and psychosocial dysfunction. Chronic pain has become a public health crisis, with annual costs exceeding $600 billion. At present, the mechanisms underlying chronic abdominal pain are not well understood, limiting the development of interventions. There is now compelling evidence that sleep deficiency may be a precursor of pain development. Additionally, sleep deficiency is associated autonomic dysfunction and affective disorders that are commonly reported by individuals with chronic abdominal pain, highlighting shared central neurobiological processes. Understanding the role of sleep deficiency as a potential mechanism of chronic abdominal pain will expand avenues for treatment. The long term goal of this research program is to develop novel strategies to interrupt the trajectories of chronic abdominal pain. The objectives of this application are to elucidate the longitudinal impact of sleep deficiency on the course of abdominal pain in adolescents, and to delineate the roles of autonomic and psychological function in this relationship. The K23 candidate is an Assistant Professor in the Department of Anesthesiology and Pain Medicine at the University of Washington, and a pediatric pain physician and anesthesiologist at Seattle Children's Hospital. This proposal outlines a well-integrated research and training plan for mentored, patient oriented career development supported by an interdisciplinary team of mentors with expertise in adolescent development, psychophysiological research, longitudinal modeling, and clinical research applications. This award will provide the candidate with specialized instruction in the evaluation of sleep and cardiophysiological biomarkers in pediatric abdominal pain populations, and expertise in the conduct of longitudinal studies. The central aims are to compare sleep deficiency, pain processing, autonomic and psychological function in adolescents with chronic abdominal pain compared to healthy adolescents (Study 1); and to evaluate these longitudinal trajectories and inter-relationships for adolescents with chronic abdominal pain compared to healthy adolescents over 6 months (Study 2). Assessments will include subjective evaluation of pain, autonomic and psychological function, in addition to home-based actigraphy monitoring of sleep patterns that will be paired with laboratory assessment of psychophysical pain tasks and heart rate variability. Data generated from this research will directly inform a planned R01 proposal to develop tailored interventions targeting sleep deficiency and autonomic function as modifiable risk factors for treatment. Completion of the proposed training will prepare the candidate for a successful independent research career in pediatric chronic abdominal pain medicine.