Longitudinal Study of Predisoposition and Life Events in Triggering Insomnia

描述(由申请人提供)：大多数失眠模型假设个人易患失眠症以及诱发因素。越来越多的证据表明，暴露在紧张的生活事件中会导致失眠。然而，研究还没有确定失眠的特征易感性，也没有调查压力暴露与这种易感性的相互作用。这项研究的目的是前瞻性地确定睡眠反应性(即非失眠症患者对压力的反应而可靠地表现出睡眠中断)在自然暴露于应激性生活事件后对慢性失眠的发展的重要性。我们已经开发并验证了一种睡眠反应性的测量方法，该方法在正常人中可以预测1)多导睡眠图对实验室应激源的睡眠障碍，以及2)在13个月的随访期内失眠的预期发展。据推测，与睡眠反应性低的人相比，没有失眠史的正常睡眠个体在病前睡眠反应性高的情况下，在暴露于应激性生活事件后更容易患上慢性失眠。在为期两年的评估期间，将从2200名没有失眠的人中收集关于他们的应激性生活事件和失眠发生率的前瞻性数据。假设这两个因素在预测失眠发生率方面的作用大于相加效应(即暴露X易感性交互作用)。实验室测量的睡眠反应性在预测失眠发生率方面的预测价值也将在4年的随访期内在随机选择的个体子集中确定。识别和跟踪可能患失眠症的人，将有助于在失眠疾病发展之前研究失眠的表型特征，改善我们对失眠的时间过程及其与发病率的关联的有限了解，有助于识别特定的触发因素及其对高危人群的影响，并允许努力针对预防而不是治疗。与公共健康相关：失眠是一种睡眠障碍，假设是由脆弱的人的压力引发的。目前的建议是一项为期两年的前瞻性研究，测试“睡眠反应性”升高是暴露在压力生活事件后发展为慢性失眠的易感风险因素这一假设。具体地说，我们假设了压力和失眠易感性之间的相互作用，在压力暴露下，有失眠倾向的人比没有失眠倾向的人有更高的疾病发生率。

DESCRIPTION (provided by applicant): Most models of insomnia hypothesize an individual predisposition to the disorder along with precipitating factors. Converging evidence suggests exposure to stressful life events can precipitate insomnia. However, research has yet to identify a trait predisposition to insomnia, or investigated the interaction of stress exposure with that predisposition. The purpose of this study is to prospectively determine the importance of sleep reactivity (i.e., non-insomniac individuals who reliably exhibit sleep disruption in response to stress) for the development of chronic insomnia following naturalistic exposure to stressful life events. We have developed and validated a measure of sleep reactivity that in normal individuals is predictive of 1) polysomnographic sleep disturbance in response to laboratory stressors and 2) the prospective development of insomnia over a 13-month follow-up period. It is hypothesized that normal sleeping individuals without a history of insomnia who have a high premorbid sleep reactivity will be at greater risk (i.e., predisposed) to developing chronic insomnia following exposure to stressful life events when compared to individuals with low sleep reactivity. Prospective data will be collected from 2,200 individuals without insomnia regarding their experiences of stressful life events and insomnia incidence during a 2-year assessment period. It is hypothesized that these two factors will have a greater than additive effect in predicting insomnia incidence (i.e., exposure X predisposition interaction). The predictive value of laboratory measured sleep reactivity in predicting insomnia incidence will also be determined in a randomly selected subset of individuals over a 4 year follow up period. Identifying and following individuals who are likely to develop insomnia will allow the study of phenotypic traits characteristic of insomnia prior to the development of the disorder, improve our limited understanding of its temporal course and its association with morbidity, help identify specific triggers and their impact in at-risk populations, and permit efforts to be directed toward prevention rather than treatment. PUBLIC HEALTH RELEVANCE: Insomnia is a sleep disorder hypothesized to be triggered by stress in vulnerable individuals. The current proposal is a 2 year prospective study testing the hypothesis that elevated "sleep reactivity" is a predisposing risk factor for the development of chronic insomnia following exposure to stressful life events. Specifically, we hypothesize an interaction between stress and the predisposition to insomnia whereby individuals with a predisposition will have a higher incidence of the disorder given stress exposure compared to non-predisposed individuals.