Insomnia Treatment and Cardiometabolic Health in Older Adults with Posttraumatic Stress Disorder

项目总结/摘要 莫妮卡·凯利博士是加州大学洛杉矶分校大卫格芬医学院的兼职助理教授。她是 完全致力于成为一个独立资助的研究者，专门从事研究和治疗 老年人睡眠、心脏代谢健康和创伤后应激障碍（PTSD）。凯利医生是理想的 该研究领域的候选人，拥有超过10年的睡眠和创伤后应激障碍研究经验，高级 老年医学研究员培训和临床心理学执照。K23奖项将提供基础 职业发展技能，以实现她的理解和改善身心健康的长期目标 失眠和创伤后应激障碍的老年人的健康结果。收集到的数据将为更大的、 随机对照试验，旨在检查最有效的治疗顺序对心理健康和 共病失眠症和创伤后应激障碍的老年人的心脏代谢疾病风险结局 职业发展和培训计划：拟议的工作将在加州大学洛杉矶分校进行，并采取 利用VAGLAHS内的可用资源，提供丰富的培训环境和能力， 执行拟议的研究和培训计划。凯利博士的全国知名导师团队包括 Drs. Jennifer Martin（初级导师;行为睡眠干预专家; K24获奖者），Cathy Alessi （老年睡眠和健康专家），Peter Liu（心脏代谢健康和睡眠专家; K24获奖者），以及 托马斯内兰（创伤后应激障碍和睡眠专家）。可用资源包括UCLA的临床和翻译 科学研究所（CTSI），老年医学和老年学多校区计划（MPGMG），以及 老年医学研究、教育和临床中心（GRECC）。她的训练计划精心策划， 教学和体验式培训，使她的研究和培训目标在1）临床试验，2）心脏代谢 健康，3）昼夜节律，以及4）成为独立临床研究者所需的职业技能。 研究计划：拟议的试点随机对照试验将解决与以下方面相关的知识缺口： 通过治疗残余失眠来解决心脏代谢疾病的可改变风险因素 老年人的创伤后应激障碍该项目利用循证干预和标准临床护理 措施该研究将评估5次认知行为治疗对失眠的益处 （CBT-I）与对照组相比，在12次认知加工疗法（CPT）治疗老年人PTSD后， 退伍军人，PTSD，失眠和心脏代谢疾病风险增加的人群 发病率和死亡率。本项目的目的是：1）评价CBT-I与对照组相比的附加效益 对睡眠、创伤后应激障碍和心脏代谢风险生物标志物的影响; 2）评估CPT后CBT-I与对照组的比较， 心脏代谢风险生物标志物和生活质量;以及3）评估睡眠、心脏代谢风险生物标志物和生活质量的持久性。 6个月随访时，CPT后CBT-I组与CPT后对照组的生活质量获益。

Project Summary/Abstract Monica Kelly, PhD is an Adjunct Assistant Professor at the David Geffen School of Medicine at UCLA. She is fully committed to becoming an independently funded investigator specializing in the study and treatment of sleep, cardiometabolic health and posttraumatic stress disorder (PTSD) in older adults. Dr. Kelly is an ideal candidate for this field of research with over 10 years of sleep and PTSD research experience, advanced geriatrics fellowship training, and licensure in clinical psychology. This K23 award will provide foundational career development skills for achieving her long-term goal of understanding and improving mental and physical health outcomes for older adults with insomnia and PTSD. Data collected will provide the basis of a larger, randomized controlled trial designed to examine the most effective treatment sequencing for mental health and cardiometabolic disease risk outcomes among older adults with comorbid insomnia disorder and PTSD. Career Development and Training Plan: The proposed work will be carried out at the UCLA and take advantage of available resources within the VAGLAHS, providing a rich training environment and the ability to conduct the proposed research and training plans. Dr. Kelly's team of nationally renowned mentors include Drs. Jennifer Martin (primary mentor; behavioral sleep interventions expert; K24 awardee), Cathy Alessi (geriatric sleep and health expert), Peter Liu (cardiometabolic health and sleep expert; K24 awardee), and Thomas Neylan (PTSD and sleep expert). Available resources include UCLA's Clinical and Translational Science Institute (CTSI), Multicampus Program in Geriatric Medicine and Gerontology (MPGMG), and the Geriatric Research, Education and Clinical Center (GRECC). Her training plan features carefully curated didactic and experiential training aligning her research and training goals in 1) clinical trials, 2) cardiometabolic health, 3) circadian rhythms, and 4) career skills necessary to become an independent clinical investigator. Research Plan: The proposed pilot randomized controlled trial will address a gap in knowledge related to addressing modifiable risk factors for cardiometabolic disease through treating residual insomnia in the context of PTSD in older adults. This project utilizes evidence-based interventions and standard clinical care measures. The study will evaluate the benefits of 5 sessions of Cognitive Behavioral Therapy for Insomnia (CBT-I) versus control, following 12 sessions of Cognitive Processing Therapy (CPT) for PTSD in older Veterans, an expanding group of individuals at elevated risk for PTSD, insomnia and cardiometabolic disease morbidity and mortality. The aims of this project are to 1) Evaluate the added benefits of CBT-I versus control on sleep, PTSD, and cardiometabolic risk biomarkers; 2) Evaluate CBT-I versus control following CPT on cardiometabolic risk biomarkers and quality of life; and 3) Evaluate the durability of the sleep, cardiometabolic and quality of life benefits of CBT-I following CPT versus control following CPT at 6-month follow-up.