2005 — 2006 |
Mccrae, Christina S |
R21Activity Code Description: To encourage the development of new research activities in categorical program areas. (Support generally is restricted in level of support and in time.) |
Sleep/Cognitive Performance/Older Adults/Insomnia
DESCRIPTION (provided by applicant): Insomnia affects up to 35 percent of individuals aged 65 and older. Although older adults with insomnia (OAWI) frequently complain of impaired cognitive functioning, objective evidence of such impairment has been sparse. Recently, however, a handful of correlational studies have found evidence of deficits in cognitive performance in OAWI. Unfortunately, because the typical correlational design utilizes 'one shot' assessments, these studies provide only a 'snapshot' of the sleep/cognition relationship. This approach could be improved as both sleep and cognitive performance may exhibit considerable day-to-day variability, particularly in older adults. Using repeated daily assessments, these fluctuations in sleep and cognition (intraindividual variability or IIV) can be captured and modeled. Because sleep is believed to play a role in cortical recovery, it is hypothesized that variability in sleep will predict variability in cognitive performance. In the proposed study, OAWI will complete daily diaries (sleep & cognitive) throughout the course of a standard behavioral treatment program for insomnia. This study is particularly innovative, because it will be the first to employ daily diary methodology and recent advances in IIV modeling in the context of an intervention design. This novel design/methodology combination will provide unique insights into the sleep/cognition relationship in OAWI and as a result, will make valuable contributions to the fields of sleep and cognition. The two (2) specific aims of this project and their associated subaims are: Aim 1: To confirm the effects of sleep treatment on sleep outcomes, and to explore transfer of sleep intervention to cognition. Subaim 1.1: To investigate influence of sleep treatment on pre-post changes in sleep and cognition. Subaim 1.2: To investigate changes in sleep and cognitive intraindividual variability as a consequence of insomnia treatment. Aim 2: To investigate the dynamic relationship between sleep and cognition over time. Subaim 2.1: To investigate concurrent associations between level and variability in sleep and cognition. Subaim 2.2: To investigate lagged relationships between level and variability in sleep and cognition. Subaim 2.3: To investigate whether there exist homogeneous subgroups with varying patterns of sleep-cognition relationships. This study is not a treatment efficacy study per se. Previous research has already shown behavioral treatment to be effective for late-life insomnia. The success of the proposed treatment will be evaluated, however, and comparisons in IIV in cognitive functioning and sleep between successfully treated and untreated individuals will be made (see Specific Aim 1).
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0.936 |
2008 — 2012 |
Mccrae, Christina S |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Sleep and Pain Interventions in Fibromyalgia: Hyperalgesia and Central Sensitizat
DESCRIPTION (provided by applicant): Approximately 50-70% of patients with chronic pain, particularly fibromyalgia sufferers, report sleep difficulties. Because it is not possible to randomly induce chronic pain or chronic insomnia in otherwise healthy participants, the exact nature of the sleep/pain relationship is not well understood. Fortunately, established cognitive behavioral treatments (CBT) treatments for insomnia (CBT-I) and pain (CBT-P) offer an excellent opportunity to examine the causal links between these two disorders. The purpose of this study is to examine the relationship between chronic pain and sleep disturbance in fibromyalgia patients. CBT-I and CBT-P will be used to examine the causal links between sleep and pain. Specific Aims 1 and 2 involve a randomized clinical trial (RCT) to evaluate the effects on sleep and pain of CBT-I and CBT-P against a waitlist control in fibromyalgia patients with insomnia. Sleep may play an etiological role in the chronicity of chronic pain conditions. Furthermore, the maintenance of chronic pain conditions can ultimately lead to a state of central sensitization (increased responsiveness of dorsal horn neurons, and perhaps other CNS structures to stimuli). Specific Aim 3 investigates the effect of improved sleep on central sensitization of pain, and Specific Aim 4 investigates the indirect effects of pain reduction on improvements in sleep outcomes. We propose to test specific hypotheses inherent in the Cognitive Activation Theory of stress (CAT). Sustained arousal and lack of arousal resolution (i.e., through restful sleep) has been implicated in the development of central sensitization. Also consistent with the CAT model is the hypothesis that negative affect (e.g., depression, anxiety) leads to central sensitization. Specific Aim 5 investigates multivariate models of the relationship of pain, sleep, negative affect, and central sensitization as a test of the Cognitive Activation Theory of stress in Fibromyalgia. Both of these hypotheses are consistent with preliminary data collected in our laboratory linking both chronic pain conditions, and negative affect to central sensitization of pain in fibromyalgia patients. Public Health Relevance Paragraph: Chronic insomnia in the context of chronic pain represents a major health threat for many Americans. This research addresses the public health need for information on the relationship between chronic insomnia and chronic pain and the effect of cognitive behavioral interventions that target insomnia (CBT-I) and pain (CBT-P) in this vulnerable population. The information to be gained has broad implications not only for other patient populations likely to suffer from insomnia and pain (i.e., cancer patients), but also for those suffering from other behavioral/heath concerns (i.e., weight management, depression).
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0.936 |
2008 — 2009 |
Mccrae, Christina S |
R21Activity Code Description: To encourage the development of new research activities in categorical program areas. (Support generally is restricted in level of support and in time.) |
Sleep in Cardiac Patients With Implantable Cardioverter Defibrillators (Icd)
DESCRIPTION (provided by investigator): Cardiac disease is the leading cause of death in the U.S. Because the Implantable Cardioverter Defibrillator (ICD) significantly reduces cardiac mortality, approximately 200,000 ICDs are implanted each year. Sleep disturbance represents a significant comorbidity for ~57 percent of ICD patients, potentially contributing to a variety of negative consequences (decreased quality of life, accidents) in this already vulnerable patient population. Unfortunately, information regarding the specific types of sleep disturbance experienced is not available. Such information is important, because different sleep disorders require very different treatment approaches. Specific Aim 1 addresses this issue by using a [3 stage] process to differentially diagnose sleep disorders in ICD patients: 1-clinical interview;2-polysomnography;3-sleep diaries. Obstructive sleep apnea (OSA) and insomnia are likely to be the two most common sleep disorders in ICD patients. Effective treatment exists for OSA. However, the best treatment approach for insomnia in these patients is unclear. Sleep medications provide effective short-term relief, but may not the best approach for chronic insomnia in ICD patients. Cognitive behavioral therapy for insomnia (CBTi) represents an attractive treatment alternative, because it is effective, carries little risk of unwanted effects, and is preferred to sleep medication by the majority of patients. Unfortunately, no definitive conclusions can be drawn about CBTi's effectiveness in ICD patients, because these patients are typically excluded from behavioral intervention protocols. Specific Aims 2 and 3 involve a randomized clinical trial (RCT) to evaluate the effects on sleep (Aim 2) and other daytime outcomes (Aim 3) of a brief cognitive-behavioral intervention against a waitlist control in ICD patients with insomnia. A brief, multiple-component CBTi protocol will be developed that includes established behavioral approaches to treating insomnia plus several novel components to target the negative cognitions and anxieties associated with cardiac disease and ICD implantation. ICD patients with insomnia will be randomly assigned to either treatment or a waitlist control. Treatment will be individually administered during 2 `in-person'sessions &2 `telephone'sessions. Sleep and other outcomes (psychological functioning, daytime functioning, [quality of life, cardiac functioning (arrhythmic burden)], and ICD adjustment will be evaluated at baseline, post treatment, &3 month follow-up. Sleep disturbance in the context of cardiac disease and ICD implantation represents a major health threat for many Americans. This research addresses the public health need for information on the types of sleep disorders experienced by ICD patients and for the development of behavioral interventions that target insomnia in this vulnerable population. The information to be gained has broad implications not only for other patient populations likely to suffer from insomnia (i.e., chronic pain), but also for those suffering from other behavioral/heath concerns (i.e., weight management, depression). PUBLIC HEALTH RELEVANCE: Sleep disturbance in the context of cardiac disease and ICD implantation represents a major health threat for many Americans. This research addresses the public health need for information on the types of sleep disorders experienced by ICD patients and for the development of behavioral interventions that target insomnia in this vulnerable population. The information to be gained has broad implications not only for other patient populations likely to suffer from insomnia (i.e., chronic pain), but also for those suffering from other behavioral/heath concerns (i.e., weight management, depression).
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0.936 |
2014 — 2015 |
Janicke, David M (co-PI) [⬀] Mccrae, Christina S |
R21Activity Code Description: To encourage the development of new research activities in categorical program areas. (Support generally is restricted in level of support and in time.) |
Cognitive Behavioral Treatment For Improving Sleep in Overweight and Obese Youth
DESCRIPTION (provided by applicant): Childhood obesity represents a major threat to public health. Sleep disturbance represents a significant comorbidity for overweight and obese (OV/OB) youth [(ages 6-12)] potentially contributing to a variety of negative consequences (lower quality of life, metabolic abnormalities) and further weight gain in this vulnerable population. Lack of sleep may contribute to increased weight status via reduced physical activity caused by fatigue; increased food intake caused by more opportunity to eat; cognitive, behavioral or mood impairments; and changes in metabolism that impact appetite or allow the body to conserve energy. Behavioral sleep disorders are more common in OV/OB youth than in general pediatric populations, with approximately 2 out of 3 OV/OB youth having significant problematic sleep behaviors. Behavioral interventions to address behavioral sleep disorders in children are efficacious in improving sleep in very young children. Improving sleep in OV/OB youth may enhance weight outcomes as improved sleep can lead to changes in energy, mood, appetite, motivation, and cues to eat that can augment a behavioral weight management intervention. Unfortunately, no research to date has examined the efficacy of cognitive behavioral treatment for child sleep (CBTcs) to address [behavioral sleep disorders (inadequate sleep hygiene, insufficient sleep syndrome, and insomnia)] in school-aged youth, nor exclusively in OV/OB youth. Preliminary evidence from our team suggests CBTcs holds great promise to improve sleep outcomes in OV/OB youth. However, more methodologically rigorous evaluation that also includes preliminary evaluation of secondary outcomes that could impact long-term weight status outcomes is needed. Thus, as the logical next step in this line of research, we propose to conduct a randomized controlled trial (RCT) that evaluates the efficacy of brief CBTcs to improve sleep in an important high-risk population, OV/OB youth with behavioral sleep disorders. OV/OB youth [(ages 6-12)] with behavioral sleep disorders (n = 60) and their parent(s) will be randomly assigned to [8 sessions] of either CBTcs or an [Educational Control (EC). CBTcs will address behavioral sleep issues in children; EC will address sleep and dietary education and general coping strategies.] Child sleep (total wake time, total sleep time, bed/wake times), height, weight, physical activity, dietary intake, quality of life (QOL), fatigue, and daytime sleepiness will be assessed at baseline, post-treatment, and 3-month follow-up.
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0.936 |