Impact of Behavioral Treatment of Insomnia on Nighttime Urine Production

项目摘要 流行，病态和昂贵（2012年为610亿美元/年），肥胖是一个主要问题，特别是对老年人。 它增加了福尔斯、骨折、抑郁、养老院安置和死亡的风险。然而， 但这仍然不够。大多数行为和药物治疗膀胱炎的重点是膀胱相关 病因，它的最普遍的属性夜间多尿（NP），或增加尿产量在睡眠中 在过去的50年里，人们对这一疾病的认识仍然不足，治疗也不充分，进展甚微。中断 白天排泄模式，夜间尿量较高，在老年人中很常见。虽然研究在 年轻人的研究表明，睡眠在调节夜间尿液分泌方面起着关键作用， 睡眠不佳在NP中的作用还未得到充分研究。 尿的产生遵循一种昼夜节律模式，其中从清醒到睡眠的过渡之后是一个明显的昼夜节律。 水、电解质和其他药理活性物质排泄减少。青年研究 人们已经确定生理性尿产生遵循昼夜节律，其受到调节 通过控制水和盐排泄的激素如精氨酸加压素分泌的昼夜变化， 肾素-血管紧张素-醛固酮系统和心钠素。睡眠不足会减弱夜间 这些激素并因此改变水和盐的排泄，从而增加夜间尿量 导致NP。 最近的证据表明，睡眠质量差，睡眠频繁中断，特别是在第一部分， 夜间和第一个不间断睡眠期的持续时间较短与NP有关，但其病理生理学 没有完全理解。此外，在睡眠不好的老年人中，我们已经表明， 针对睡眠的干预（BBTI-失眠的简短行为治疗， 失眠症的多模式行为治疗）不仅改善睡眠，而且改善失眠症。因此，我们假设 在睡眠的第一阶段睡眠中断会影响夜间尿液的荷尔蒙调节 产生NP。此外，我们假设，延长第一次不间断睡眠的干预措施， 时间会减少NP，从而减少Np。 本提案的目的是：1）检查BBTI对第一次 不间断睡眠时间和NP在老年痴呆症;和2）建立NP和持续时间的第一次 不间断的睡眠是BBTI影响睡眠的机制。我们的假设是BBTI改善了 不仅通过改善睡眠（特别是第一个不间断睡眠期的持续时间）， 减少NP。 为了实现我们的目标，我们将招募60名社区居住的成年人（年龄>65岁），患有神经性肺炎和NP。睡眠 将通过失眠严重程度指数进行主观评估，并通过7天睡眠日记和腕关节进行客观评估。 活动记录仪。同时，我们将收集3天的膀胱日记数据，以记录他们的排尿模式和量 在白天和晚上。参与者将随机接受为期4周的行为睡眠干预BBTI 由受过训练的治疗师或信息控制干预。参与者将重复研究措施 干预后。 研究结果将为睡眠不良的共同病理机制提供重要的见解， 排尿和夜间排尿。我们将利用这些发现来构建一个更大的R 01， NP的老年生物学机制，调节盐和水排泄的激素的昼夜节律，以及 睡眠治疗对这些节律的影响。

PROJECT SUMMARY Prevalent, morbid, and costly ($61 billion/year in 2012), nocturia is a major problem, especially for older adults. It increases the risk of falls, fractures, depression, nursing home placement, and death. Yet management of nocturia remains inadequate. Most behavior and pharmacotherapies for nocturia focus on bladder-related etiologies, and it’s most prevalent attribute nocturnal polyuria (NP), or increased urine production during sleep remains poorly understood and inadequately treated with little advancement over the last 50 years. Disruption of diurnal excretory pattern, with higher nighttime urine production is common in older adults. While studies in young adults show that sleep plays a critical role in regulating nighttime urine production, among older adults the role of poor sleep in NP is under-investigated. Urine production follows a circadian pattern in which transition from wake to sleep is followed by a pronounced decrease in excretion of water, electrolytes and other osmotically active substances. Studies in young population have established that physiological urine production follows a circadian rhythm, which is regulated by diurnal variation in secretion of hormones controlling water and salt excretion such as arginine vasopressin, renin-angiotensin-aldosterone system, and atrial natriuretic peptide. Sleep deprivation blunts nocturnal surge of these hormones and consequently alter water and salt excretion thereby increase nighttime urine volume leading to NP. Recent evidence suggests that poor sleep quality, frequent sleep interruptions especially in the first part of the night and shorter duration of first uninterrupted sleep period are associated with NP but its pathophysiology is not fully understood. Additionally, among older adults with poor sleep, we have shown that a behavioral intervention directed solely towards sleep (BBTI- brief behavioral treatment of insomnia an efficacious multimodal behavioral treatment for insomnia) not only improves sleep, but also nocturia. Hence, we postulate that sleep interruptions in the first part of the sleep impacts the hormonal regulation of nighttime urine production causing NP. In addition, we postulate that interventions to prolong the first uninterrupted sleep period will decrease NP and hence nocturia. The, aims of the present proposal are to: 1) examine the impact of BBTI on duration of the first of uninterrupted sleep period and NP in elderly with nocturia; and 2) establish NP and duration of first uninterrupted sleep as mechanisms by which BBTI impacts nocturia. Our hypothesis is that BBTI improves nocturia not only by improving sleep, (and specifically, duration of the first uninterrupted sleep period), but also by decreasing NP. To accomplish our goals we will recruit 60 community dwelling adults (aged >65) with nocturia and NP. Sleep will be assessed subjectively with the Insomnia Severity Index and objectively by 7-day sleep diary and wrist actigraph. Concurrently we will collect 3-day bladder diary data to document their voiding pattern and volume during day and night. Participants will be randomized to receive the 4-week behavioral sleep intervention BBTI by a trained therapist or an information control intervention. The participants will repeat the study measures post-intervention. The study results will provide important insights into shared pathological mechanisms underlying poor sleep, nocturia and nighttime urine production. We will use these findings to construct a larger R01 to explore in the elderly biological mechanisms of NP, circadian rhythms of hormones regulating salt and water excretion, and the impact of sleep treatment on these rhythms.