Cardiovascular disease (CVD) is the world's leading cause of morbidity and mortality, and evidence is mounting that sleep disturbance-which is chronically experienced by approximately one-third of the adult population-may be a prominent risk factor. The majority of research thus far has focused on the cardiovascular consequences of sleep disordered breathing, though there is compelling epidemiologic evidence that insomnia, particularly insomnia with short sleep duration, may be associated with increased CVD risk. Identification of increased CVD risk for this sleep phenotype would have significant
, as it may be possible for appropriate behavioral interventions (once developed) to modify this risk via improving sleep. However, standard behavioral treatment for insomnia, cognitive behavioral therapy, is limited for this sleep phenotype due to restrictions upon the implementation of sleep restriction therapy. There is excellent rationale that exercise may be an ideal adjunct treatment for this sleep phenotype. The first aim of the research plan is to investigate whether insomnia with objective short sleep duration is associated with subclinical CVD, as assessed by insulin resistance and brachial artery flow-mediated dilation, compared to good sleeper control participants. The second aim of the research plan is to examine the relationship between subclinical CVD and nocturnal physiological arousal, as assessed by cortical, autonomic and neuroendocrine indices of physiological arousal. The third aim of the research plan is to develop, refine and assess the safety and feasibility of a novel behavioral intervention, cognitive behavioral therapy for insomnia combined with exercise, in a subset of adults with insomnia and short sleep duration. To achieve the goals of the research plan and my long-term goal of becoming an independent researcher studying how behavioral interventions reduce CVD risk through improved sleep, this Career Development Award will provide further training in the following areas: (1) the measurement of subclinical CVD and physiological correlates of CVD risk; (2) the behavioral treatment of insomnia; and (3) the design and conduct of randomized controlled trials. As insomnia is the most common sleep disorder, this proposal carries significant public health relevance as it could serve to characterize an objectively define insomnia phenotype-insomnia with objective short sleep duration-with increased CVD risk and demonstrate development of a feasible and appropriate behavioral treatment for this phenotype. Findings from the proposed studies will provide novel and clinically relevant information and provide a foundation for a long-term career studying how behavioral interventions reduce CVD risk through improved sleep. PUBLIC HEALTH RELEVANCE: Insomnia is the most common sleep disorder, and there is accumulating evidence of its association with increased CVD risk. This project will examine the association between a specific insomnia phenotype, insomnia with objective short sleep duration, and CVD risk using a well-characterized diagnosed insomnia sample, objective markers of CVD risk, and measurement of nocturnal physiological arousal, and we will develop, refine and assess the feasibility and safety of a novel behavioral intervention for this phenotype. The proposed research has significant public health relevance due to the high prevalence of insomnia and the possibility that its increased CVD risk may be modifiable.
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