Aging: Insomnia Treatment and Energy Balance

描述(申请人提供)：超过50%的65岁以上的成年人报告有睡眠问题，在这一人群中，持续性失眠的流行率估计超过30%，并随着年龄的增长而稳步增加。慢性失眠的行为治疗显示自我报告的睡眠持续改善，但结果评估，包括多导睡眠图、健康功能等行为因素和睡眠影响的生物因素尚未得到全面检查，特别是在老年人中。特别是，一个有希望的研究领域是干预对能源平衡的影响。生长激素和瘦素被认为向大脑传递能量平衡的信息，这些激素的失调会导致食欲增加和脂肪积累。流行病学研究发现，睡眠不佳与生长激素升高和瘦素降低有关，实验睡眠限制研究也证实了这一点。胃促生长素水平升高和瘦素水平降低也与交感神经活动增强有关，这在失眠患者中可以看到。综上所述，这些发现表明，老年失眠患者可能改变了能量平衡。然而，很少有研究衡量失眠干预后的客观睡眠评估，也没有研究报告它对能量平衡的影响。这项拟议的项目是一项新资助的NIA随机对照试验的辅助研究，该试验比较了认知行为疗法(CBT)、太极拳疗法(TCC)和卫生/教育控制(EC)对老年失眠患者睡眠结果的影响。这个K23项目是一个机会，让PI(一名健康临床心理学家)利用睡眠和心理生理学评估以及之前的临床培训方面的专业知识，同时发展行为失眠治疗研究和治疗的生物效应方面的专业知识。这个K23项目的独特目的是：1)在基线、治疗中期、治疗后、3个月和12个月的随访中，评估CBT与TCC与EC对Ghrelin和Leptin水平的影响；2)在加州大学洛杉矶分校GCRC的睡眠评估中，确定CBT与TCC与EC对夜间自主神经功能(心率变异性的功率谱分析)的影响；3)在治疗试验过程中，检查能量平衡和自主神经功能是否与睡眠客观和主观指标的改善有关。

DESCRIPTION (provided by applicant): Over 50% of adults older than 65 years report problems sleeping and the prevalence of persistent insomnia is estimated to be over 30% in this population, and steadily increases with age. Behavioral treatments for chronic insomnia have demonstrated consistent improvements in self-reported sleep, but outcome assessment, including polysomnography, behavioral factors such as health functioning and biologic factors impacted by sleep have not been comprehensively examined, especially in older adults. In particular, one promising area of research is the impact of interventions on energy balance. The hormones ghrelin and leptin are thought to convey information about energy balance to the brain, and dysregulation of these hormones lead to increases in appetite and lipid accumulation. Epidemiologic studies have found that poor sleep is associated with elevated ghrelin and decreased leptin, corroborated by experimental sleep restriction studies as well. Elevated ghrelin and decreased leptin levels also correlate with increased sympathetic activity; which is seen in insomnia patients. Taken together, these findings indicate that older insomnia patients may have altered energy balance. Yet few studies have measured objective sleep assessment following insomnia interventions and no study has reported its effects on energy balance. The proposed project is an ancillary study to a newly funded NIA randomized, controlled trial comparing the effects of cognitive-behavioral therapy (CBT), Tai Chi Chih (TCC), and hygiene/education control (EC) on sleep outcomes in older insomnia patients. This K23 project is an opportunity for the PI (a health-clinical psychologist) to utilize expertise in sleep and psychophysiology assessment and previous clinical training while developing expertise in behavioral insomnia treatment research and biological effects of treatment. The unique aims of this K23 project are to: 1) evaluate the effects of CBT vs. TCC vs. EC on ghrelin and leptin levels at baseline, mid- treatment, post-treatment and 3- and 12-month follow-ups; 2) determine the effects of CBT vs. TCC vs. EC on nocturnal autonomic function (power spectral analysis of heart rate variability) during sleep assessments at the UCLA GCRC at baseline and post-treatment; 3) examine whether energy balance and autonomic function are related to improvements in objective and subjective measures of sleep over the course of the treatment trial.