ACEs, CBT-i, and Cardiovascular Health

Sleep disruption is an important, emerging risk factor for CMD morbidity and mortality \[9\], and is associated with leading cardiometabolic risk factors such as hypertension, insulin resistance, and obesity \[1,2\]. It is likely that poor sleep increases CMD-related risk by promoting circadian disruption \[3\]. A growing body of evidence suggests that ACEs are associated with disturbed sleep. Indeed, strong preliminary evidence from our laboratory indicates that young adults with a history of ACEs self-report poor sleep and present with altered diurnal cortisol concentrations indicative of disrupted circadian variation \[4\]. Accordingly, our hypothesis is that sleep disruption is a hallmark, stress-related symptom of ACEs, and therefore that sleep disruption is a modifiable, mechanistic pathway by which ACEs promote CMD risk. Accordingly, building on our initial data indicating that poor sleep mediates the association between ACE exposure and vascular and metabolic dysfunction, our overall objective in this pilot project is to first (1) test the first line treatment to improve sleep among those suffering from insomnia (CBT-i) for improving sleep in individuals with high ACEs and sleep disruption and (2) explore whether this intervention promotes positive effects on vascular and metabolic health, as well as psychological coping, stress, and anxiety/depression symptoms.

1. St-Onge MP, Grandner MA, Brown D, et al. Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association. Circulation.

2016;134(18):e367-e86.
2. Cappuccio FP, Miller MA. Sleep and Cardio-Metabolic Disease. Curr Cardiol Rep. 2017;19(11):110.
3. Reutrakul S, Knutson KL. Consequences of Circadian Disruption on Cardiometabolic Health. Sleep Med Clin. 2015;10(4):455-68.
4. Jenkins NDM, Rogers EM, Banks NF, et al. Adverse childhood experiences are linked to disrupted sleep and diurnal cortisol concentrations in young adult women. Circulation. 2022;145:AMP46

Participants will undergo a CBT-i intervention delivered by clinical psychologists using telehealth inside of the UIowa Zoom ecosystem.

Behavioral: Cognitive Behavioral Therapy for Insomnia

The CBT-i intervention will be delivered by clinical psychologists (overseen by an experienced PhD-level Clinical Psychologist) who have completed CBT-i training at the University of Iowa. CBT-i is modular, manualized (see example in miscellaneous attachments), and thus highly standardized. CBT-i is the recommended first line treatment for those with insomnia (improving sleep in 75% of these) and has also shown efficacy for improving sleep in those with sub-clinical insomnia and with stress disorders (e.g., PTSD). CBT-i will be delivered in 6, \~1 hour sessions across the course of 6-7 weeks and the topics covered in each session (in order) will be: 1) Sleep Basics, 2) Sleep Schedules, 3) Sleep Hygiene, 4) Stress Management:Relaxation, 5) Stress Management: Stop Worrying About Sleep, 6) Stress Management: Problem Solving.

The intervention sessions will be delivered using telehealth inside of the UIowa Zoom ecosystem using private links.

Plazo: Prior to and at the end of 6 week CBT-I intervention

Brachial artery flow mediated dilation will be measured as a non-invasive indicator of endothelial function.

Plazo: Prior to and at the end of 6 week CBT-I intervention

Heart rate signals will be recorded using 3-lead ECG for 10 minutes while the participant rests quietly for measurement of heart rate and heart rate variability

Plazo: Prior to and at the end of 6 week CBT-I intervention

Beat-to-beat blood pressure signals will be recorded using finger photoplethysmography for 10 minutes while the participant rests quietly for measurement of blood pressure and blood pressure variability

Plazo: Prior to and at the end of 6 week CBT-I intervention

A fasting blood sample will be drawn to calculate HOMA-IR as (fasting glucose \[mg/dL\] x fasting insulin \[uIU/mL\] / 405)

Plazo: Prior to and at the end of 6 week CBT-I intervention

Participants will have their waist circumference measured using a flexible Gulick tape.

Cognitive Behavioral Therapy for Insomnia to Improve Sleep Quality, Stress, and Vascular and Metabolic Health in Young Adults With Early Life Adversity and Poor Sleep: A Pilot Study.