Despite its extraordinary prevalence, increasing incidence across the lifespan, and consequences, the pathophysiology of insomnia and, specifically, the pathways by which morbidity risk is conferred, have been relatively unstudied. The specific goal for this K-Award is to engage in a program of training and developing research that will allow the applicant to blend psychoneuroimmunology (PNI) and insomnia research, and to foster a program of investigation that seeks to delineate how two perpetuating processes of insomnia (hyperarousal and homeostatic dysregulation) affect health outcomes in general, and immune function in particular. The development program detailed in this application is structured to provide the applicant training in PNI, biostatistics, grantsmanship, the ethical conduct of research, and how one engages with minority communities.
The specific aim for the proposed research project is to ascertain whether chronic insomnia is associated with a blunted adaptive immune response to an experimental challenge. This study uses a two-group, parallel arm study of 50 pre-menopausal female subjects aged 30-50 (25 with chronic insomnia [Pis] and 25 good sleepers [GSs]) to assess whether insomnia is associated with a blunted antibody response to a Hepatitis B vaccine challenge. Each subject will receive the established 3-part vaccine regimen, with blood draws to determine protective antibody levels following each administration. The central hypothesis to be tested is that Pis will have lower antibody titers (a continuous measure) and lower sero-conversion rates (a dichotomous measure) than GSs following the 1st and 2nd vaccinations. In addition to the specific assessment of immunocompetence, sleep continuity will be assessed daily with sleep diaries;health status will be assessed weekly with symptom checklists. These assessments will occur over a three month period. The value of the proposed career training program and the related research resides in the development of the PI as an individual with the skills and background to bridge traditionally separate domains of investigation, and its capacity to operationally define immunocompetence in a manner'that is likely to be directly related to health outcomes, to do so in a clinical population believed to be at risk for significant medical morbidity, and with a condition that becomes increasingly pronounced with aging.
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