Bringing medical advances from the lab to the clinic.
在失眠研究领域，近年来出现了多项新的诊断和治疗进展：
数字化疗法：数字化认知行为疗法（dCBT-I）通过手机应用和在线平台，为失眠患者提供方便的治疗选择。这种方法提高了治疗的可及性，特别适用于无法定期面访的患者。
新型药物：一些新药物，如食欲素受体拮抗剂（如苏沃雷生），已经被批准用于治疗失眠。这类药物通过调节大脑中的觉醒通路，促进睡眠且副作用较少。
神经调控技术：非侵入性的神经调控方法，如经颅磁刺激（TMS）和经颅直流电刺激（tDCS），被用于研究和治疗失眠。这些技术通过调节大脑活动，可能改善睡眠质量。
生物标志物研究：科学家正在寻找与失眠相关的生物标志物，以实现更精准的诊断和个性化治疗。这包括基因、炎症指标和脑电图模式等方面的研究。
尽管近年来在失眠的诊断和治疗方面取得了显著进展，但仍存在一些重要而未解决的临床问题：
个体差异：失眠的原因多种多样，包括压力、焦虑、环境因素、生理疾病等，治疗需要针对具体原因，但并不是所有患者的原因都能清晰识别。 长期效果：目前常见的治疗方法如行为疗法、药物治疗等在短期内有效，但对于长期效果仍存在争议，特别是药物治疗可能导致依赖性和耐药性。 安全性和副作用：常用的失眠药物如苯二氮卓类药物和非苯二氮卓类药物，虽然普遍用于治疗失眠，但可能带来诸如昼间嗜睡、记忆问题等副作用。 综合治疗方法：失眠往往与其他精神健康问题如抑郁、焦虑共病，需要综合性治疗方案，而目前这方面的研究和实践还不充分。
JOHNS HOPKINS UNIVERSITY 的 HUHN, ANDREW S PENNSYLVANIA STATE UNIV HERSHEY MED CTR 的 VGONTZAS, ALEXANDROS N UNIVERSITY OF PENNSYLVANIA 的 GEHRMAN, PHILIP RICHARD UNIVERSITY OF SOUTH FLORIDA 的 MCCRAE, CHRISTINA S VIRGINIA COMMONWEALTH UNIVERSITY 的 MARTIN, CAITLIN EILEEN
约翰霍普金斯大学
弗吉尼亚联邦大学
宾夕法尼亚州立大学赫尔希医学中心
加州大学旧金山分校
密歇根大学安娜堡分校等
Background: Sleep disturbances, particularly insomnia, are prevalent in cancer patients undergoing chemotherapy. Our clinically based Brief Behavioral Therapy for Cancer-Related Insomnia (BBT-CI) is a new approach for treating insomnia symptoms during cancer care and can serve as a model for other behavioral interventions during medical treatment. Our design allows us to capture patients just as they are developing insomnia symptoms, but before their problems become chronic and require more intensive intervention. Our behavioral intervention is innovative because we can deliver it in tandem with patients’ biomedical treatments, at the bedside, which significantly reduces patient burden. BBT-CI is a brief (2 face-to-face meetings, four 15-minute phone calls), feasible and acceptable intervention that has shown promise in reducing insomnia and other cancer-related side effects and in improving circadian rhythms at four community oncology clinic sites.
Methods: The proposed project will test the efficacy of a novel BBT-CI in multiple private practice clinical oncology settings (n=20) across the country through the University of Rochester Cancer Center NCI Community Oncology Research Program (NCORP). We propose to randomize 400 cancer patients receiving chemotherapy to either BBT-CI or Healthy EAting Education Learning for healthy sleep (HEAL). Our HEAL control condition has been tested in our preliminary trial and is matched to BBT-CI for time and attention while excluding active components of the BBT-CI intervention (i.e., stimulus control, physical activity, circadian entrainment).
The proposed innovative study will: 1) test the efficacy of a novel BBT-CI intervention in a community setting (NCORP network), 2) train nurses and clinical assistants to deliver the intervention in the infusion clinic, making it easier to disseminate in the future, and 3) elucidate the psychophysiology of insomnia and treatment response by collecting physiological circadian and autonomic nervous system markers. The proposed study aims to change the paradigm of how behavioral treatments can be delivered by creating and delivering the intervention in tandem with acute cancer care.
