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。这项提案概述了一项综合良好的研究和 由一个跨学科团队支持的有指导、以患者为导向的职业发展培训计划 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。中心目标是比较睡眠不足、疼痛处理、自主神经 慢性腹痛青少年与健康青少年的心理功能比较 (研究1)；并评估这些纵向轨迹和青少年慢性病患者的相互关系 6个月以上的腹痛与健康青少年的比较(研究2)。评估将包括主观评估 疼痛、自主神经和心理功能的评估，以及基于家庭的运动监测 睡眠模式将与心理物理疼痛任务和心率的实验室评估相匹配 可变性。这项研究产生的数据将直接为计划中的R01提案提供信息，以开发定制的 针对睡眠不足和自主神经功能的干预措施是治疗的可改变的危险因素。

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. 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. 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.