Sleep-wake disturbances in adolescents with chronic pain

描述(申请人提供)：慢性疼痛是一个重要的公共卫生问题，影响多达25%的青少年。在这些青少年中，超过一半的人报告说，睡眠障碍，如失眠，可能会削弱正常的日常功能，扰乱情绪，阻碍生活质量。由于缺乏对这些睡眠-觉醒障碍的具体性质和诊断特征的了解，儿科疼痛人群中的睡眠问题的治疗尚未开发出来。这项研究计划的长期目标是开发有效的治疗方法，减少儿童和青少年的慢性疼痛和睡眠障碍。该应用程序的具体目标是：1)使用主观调查测量和活动记录法来表征患有慢性疼痛的青少年所经历的睡眠-觉醒障碍的性质和影响；2)确定与疼痛和睡眠关系相关的行为和心理因素；以及3)确定12个月的睡眠-觉醒障碍的轨迹。这项纵向研究由三个数据波组成。时间1是对240名12至17岁青少年的睡眠模式和行为以及与睡眠相关的心理因素的横断面比较，其中60名青少年患有慢性非恶性疼痛，60名青少年患有原发行为睡眠障碍，60名青少年患有严重抑郁障碍，60名青少年同龄人其他方面健康。将对睡眠进行主观和客观评估。动态动作记录将在10天内完成，青少年将完成主观睡眠测量和电子睡眠和行为日记。行为评估将包括精神筛查访谈、症状清单和睡前唤醒的测量。时间2和时间3数据波将在研究进入后6个月和12个月出现。将对睡眠、疼痛和行为因素进行反复评估，以检验随着时间的推移睡眠障碍的预测因素。此外，将使用日常评估方法来测试抑郁情绪在疼痛和睡眠关系中所起作用的中介模型。通过拟议的研究获得的知识预计将对儿童和青少年的健康产生积极影响，因为它将允许开发旨在减少疼痛和睡眠干扰的新干预措施。这些进展可能最终改善受慢性疼痛影响的大量青少年的适应功能和生活质量，并使人们更好地理解如何预防成年后出现致残、代价高昂的疼痛和睡眠问题。

DESCRIPTION (provided by applicant): Chronic pain is an important public health issue, affecting as many as 25% of adolescents. Over half of these adolescents report sleep disturbances, such as insomnia, that have the potential to diminish normal daily function, disturb mood, and hinder quality of life. Treatments for sleep problems in pediatric pain populations have not been developed due to lack of knowledge of the specific nature and diagnostic characteristics of these sleep-wake disturbances. The long-term goal of this research program is to develop effective treatments that reduce both chronic pain and sleep disturbances in children and adolescents. The specific aims of this application are to 1) characterize the nature and impact of sleep-wake disturbances experienced by adolescents with chronic pain using subjective survey measures and actigraphy, 2) identify behavioral and psychological factors associated with the pain and sleep relationship, and 3) determine trajectories in sleep-wake disturbances over 12 months. This longitudinal study is composed of three data waves. Time 1 is a cross-sectional comparison of sleep patterns and behaviors, and psychological factors associated with sleep in 240 adolescents, ages 12 to 17 years, (n=60 adolescents with chronic nonmalignant pain, n=60 adolescents with a primary behavioral sleep disorder, n=60 adolescents with major depressive disorder, and n=60 otherwise healthy adolescent peers). Subjective and objective assessment of sleep will be conducted. Ambulatory actigraphy recordings will be completed over 10 days and adolescents will complete subjective sleep measures and an electronic sleep and behavior diary. Behavioral assessment will include a psychiatric screening interview, symptom inventories, and a measure of pre-sleep arousal. Time 2 and Time 3 data waves will occur at 6 and 12 months post study-entry. Repeated assessments of sleep, pain, and behavioral factors will be conducted to examine predictors of sleep disturbances over time. In addition, daily assessment methodology will be used to test a mediation model of the role of depressed mood in the relationship between pain and sleep. Knowledge gained by the proposed studies is expected to positively affect the health of children and adolescents because it will allow the development of new interventions that are designed to decrease pain and sleep disturbances. These advances may ultimately improve the adaptive functioning and quality of life of the substantial population of adolescents affected by chronic pain, and lead to a better understanding of how to prevent the development of disabling, costly pain and sleep problems in adulthood.