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Impact of GHRH on Sleep Promotion and Endocrine Regulation in Service Members Who Sustained a Traumatic Brain Injury and Have Current Insomnia

Primary Purpose

Sleep Disorder, Traumatic Brain Injury

Status
Withdrawn
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Tesamorelin
Placebo
Sponsored by
National Institute of Nursing Research (NINR)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Sleep Disorder focused on measuring Growth Hormone, Traumatic Brain Injury, Insomnia, Polysomnography, NREM Sleep

Eligibility Criteria

18 Years - 45 Years (Adult)All SexesDoes not accept healthy volunteers
  • INCLUSION CRITERIA:

Both groups may be eligible for this research study if they:

  1. Are between 18 and 45 years of age (on Visit 1)
  2. Are active duty service members or veterans who were active duty within the past 10 years (on Visit 1)
  3. Are able to provide medical records documenting a TBI, which occurred within the past 6 months to 10 years (on Visit 1)
  4. Are able to provide their own consent
  5. Are able to understand the study, as shown by scoring a 6 out of 6 on a consent quiz
  6. (For women only) agree not to breastfeed from the time of enrollment in the study until 1 month after the last exposure to tesamorelin
  7. (For women of childbearing potential only) have a negative urine pregnancy test and agree to use two effective methods of contraception from the time of enrollment in the study until 1 month after the last exposure to tesamorelin

The insomnia group may be eligible for this research study if they:

  1. Have a current clinical diagnosis of insomnia determined by polysomnography
  2. Have a PSQI score greater than 10

The no-insomnia group may be eligible for this research study if they:

  1. Have no current clinical diagnosis of insomnia determined by self-report
  2. Have a PSQI score less than or equal to 5

EXCLUSION CRITERIA:

Both groups may not be eligible for this research study if they:

  1. Have obstructive sleep apnea determined by polysomnography (insomnia group) or selfreport (no-insomnia group)
  2. Have a known hypersensitivity to tesamorelin and/or mannitol
  3. Have taken any of the following medications within the past 30 days: benzodiazepines (e.g., Valium, Ativan, etc.); benzodiazepine receptor agonists (e.g., Ambien, Lunesta, etc.); opiates (e.g., Codeine, Percocet, etc.); or sedatives (e.g., Amytal, Numbutal, etc.)
  4. Cannot abstain from using stimulants such as amphetamines (e.g., Adderall, Ritalin, etc.); caffeine (e.g., coffee, cola, etc.); ephedrine (e.g., diet pills, energy drinks, etc.); and eugeroics (e.g., Modafinil, Provigil, etc.) from at least 9:00 AM on Visits 2 and 3
  5. Are under treatment for a major injury (e.g., amputation, burns, eye injury, skeletal injury, severe infection, etc.)
  6. Have a major medical illness (e.g., active malignancy, cardiovascular disease, diabetes mellitus, HIV, etc.)
  7. Are at risk for self-harm determined by a licensed independent practitioner
  8. Have indications of recreational substance use determined by a urine drug test
  9. Have an abnormal lab value that may indicate major medical illness, which was not cleared by a licensed independent practitioner
  10. Have an abnormal lab value that may indicate endocrine dysfunction, which was not cleared by a licensed independent practitioner
  11. Have adrenal insufficiency determined by the ACTH stimulation test
  12. Have a current bipolar disorder determined by the SCID-IV-TR
  13. Have a current psychotic disorder determined by the SCID-IV-TR
  14. Have current alcohol dependence determined by the SCID-IV-TR
  15. Have current drug dependence determined by the SCID-IV-TR

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Placebo Comparator

    Experimental

    Arm Label

    Placebo

    Tesamorelin

    Arm Description

    Salt Water Solution

    Growth Hormone-Releasing

    Outcomes

    Primary Outcome Measures

    Change in NREM time following tesamorelin administration compared to placebo

    Secondary Outcome Measures

    Within and between group differences in plasma concentration levels of neuroendocrine proteins following tesamorelin administration compared to placebo

    Full Information

    First Posted
    October 12, 2016
    Last Updated
    November 16, 2019
    Sponsor
    National Institute of Nursing Research (NINR)
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02931474
    Brief Title
    Impact of GHRH on Sleep Promotion and Endocrine Regulation in Service Members Who Sustained a Traumatic Brain Injury and Have Current Insomnia
    Official Title
    The Impact of GHRH on Sleep Promotion and Endocrine Regulation in Service Members Who Sustained a Traumatic Brain Injury and Have Current Insomnia
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    March 8, 2017
    Overall Recruitment Status
    Withdrawn
    Study Start Date
    October 6, 2016 (undefined)
    Primary Completion Date
    March 8, 2017 (Actual)
    Study Completion Date
    March 8, 2017 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    National Institute of Nursing Research (NINR)

    4. Oversight

    5. Study Description

    Brief Summary
    Background: People who have had a traumatic brain injury (TBI) often have trouble sleeping. TBI may also alter hormones, which can cause poor sleep. Researchers believe that a form of growth hormone releasing hormone (GHRH) might improve sleep in service members and veterans who have had a TBI. Objective: To see if GHRH can improve sleep in people who have had a TBI. Eligibility: Active duty service members or veterans (active duty in the past 10 years) ages 18-45 who have had a TBI in the past 6 months to 10 years. Design: Participants will be screened with: Medical history Physical exam Blood and urine tests Getting ACTH (a hormone) through an intravenous catheter (thin plastic tube) Interview about their mood and alcohol and drug use Questionnaires about their TBI, mood, and sleep Participants will have 2 overnight study visits a couple weeks apart. These will include: Physical exam Urine sample Two intravenous catheters placed. Blood samples will be taken throughout the night. Two shots under the skin of the belly. The shots will be GHRH on one visit and placebo on the other. Spending the night in the sleep lab. Their brain waves will be recorded with electrodes placed on the scalp. A questionnaire in the morning about their sleep Participants will be called a few days after each overnight visit. They will be asked about how they are feeling and to rate their sleep.
    Detailed Description
    Objective: Traumatic brain injury (TBI) is the hallmark injury of deployment in Iraq and Afghanistan. Up to one-third of service members who sustain a TBI are diagnosed with a sleep disorder; insomnia being one of the most common. Currently, over half of TBI-associated insomnia cases remain untreated due to poor efficacy of available pharmacologic agents. Neuroendocrine dysfunction is an important mechanism linking TBI and disordered sleep, thus pharmacological agents that address this dysfunction may be effective in treating TBI-related insomnia. The neuroendocrine system is essential for regulating sleep and circadian function. Decreased neuroendocrine function, including the hypothalamus and the somatotrophic cells of the anterior pituitary, which regulate growth hormone secretion, likely contributes to insomnia. This assertion is supported by previous studies that demonstrated the sleep-promoting effects of growth hormone releasing hormone (GHRH) administration in healthy controls, the elderly, and participants with depression. Therefore, we propose that administration of GHRH will address the underlying mechanisms of insomnia in service members and veterans who sustained a TBI, and provide a pharmacological agent more robust than currently available treatments. Study population: This study will recruit 50 active duty service members and veterans with a documented TBI to participate in one of two study groups. The insomnia group (n=25) will include participants that have a current clinical diagnosis of insomnia without obstructive sleep apnea. The no-insomnia group (n=25) will include participants with no current clinical diagnosis of insomnia or obstructive sleep apnea. Withdrawals/dropouts will be replaced to obtain 20 participants per group who complete the study. Design: A double-blind, randomized, crossover design will be used to examine the impact of tesamorelin (GHRH (1-44) analog) or placebo on total non-rapid eye movement (NREM) time evaluated during two polysomnography visits, scheduled 1-3 weeks apart. Serial blood draws will be obtained during the polysomnography to examine endocrine function and neuropeptide release. Outcome measures: The primary outcome is change in NREM time following tesamorelin administration compared to placebo. The secondary outcomes are (1) within and between group differences in plasma concentration levels of neuroendocrine proteins following tesamorelin administration compared to placebo and (2) within and between group differences in urinary concentration levels of growth hormone following tesamorelin administration compared to placebo.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Sleep Disorder, Traumatic Brain Injury
    Keywords
    Growth Hormone, Traumatic Brain Injury, Insomnia, Polysomnography, NREM Sleep

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Crossover Assignment
    Masking
    ParticipantCare ProviderInvestigator
    Allocation
    Randomized
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Placebo
    Arm Type
    Placebo Comparator
    Arm Description
    Salt Water Solution
    Arm Title
    Tesamorelin
    Arm Type
    Experimental
    Arm Description
    Growth Hormone-Releasing
    Intervention Type
    Drug
    Intervention Name(s)
    Tesamorelin
    Intervention Description
    Growth Hormone-Releasing
    Intervention Type
    Other
    Intervention Name(s)
    Placebo
    Primary Outcome Measure Information:
    Title
    Change in NREM time following tesamorelin administration compared to placebo
    Time Frame
    1-3 weeks
    Secondary Outcome Measure Information:
    Title
    Within and between group differences in plasma concentration levels of neuroendocrine proteins following tesamorelin administration compared to placebo
    Time Frame
    1-3 weeks

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    45 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    INCLUSION CRITERIA: Both groups may be eligible for this research study if they: Are between 18 and 45 years of age (on Visit 1) Are active duty service members or veterans who were active duty within the past 10 years (on Visit 1) Are able to provide medical records documenting a TBI, which occurred within the past 6 months to 10 years (on Visit 1) Are able to provide their own consent Are able to understand the study, as shown by scoring a 6 out of 6 on a consent quiz (For women only) agree not to breastfeed from the time of enrollment in the study until 1 month after the last exposure to tesamorelin (For women of childbearing potential only) have a negative urine pregnancy test and agree to use two effective methods of contraception from the time of enrollment in the study until 1 month after the last exposure to tesamorelin The insomnia group may be eligible for this research study if they: Have a current clinical diagnosis of insomnia determined by polysomnography Have a PSQI score greater than 10 The no-insomnia group may be eligible for this research study if they: Have no current clinical diagnosis of insomnia determined by self-report Have a PSQI score less than or equal to 5 EXCLUSION CRITERIA: Both groups may not be eligible for this research study if they: Have obstructive sleep apnea determined by polysomnography (insomnia group) or selfreport (no-insomnia group) Have a known hypersensitivity to tesamorelin and/or mannitol Have taken any of the following medications within the past 30 days: benzodiazepines (e.g., Valium, Ativan, etc.); benzodiazepine receptor agonists (e.g., Ambien, Lunesta, etc.); opiates (e.g., Codeine, Percocet, etc.); or sedatives (e.g., Amytal, Numbutal, etc.) Cannot abstain from using stimulants such as amphetamines (e.g., Adderall, Ritalin, etc.); caffeine (e.g., coffee, cola, etc.); ephedrine (e.g., diet pills, energy drinks, etc.); and eugeroics (e.g., Modafinil, Provigil, etc.) from at least 9:00 AM on Visits 2 and 3 Are under treatment for a major injury (e.g., amputation, burns, eye injury, skeletal injury, severe infection, etc.) Have a major medical illness (e.g., active malignancy, cardiovascular disease, diabetes mellitus, HIV, etc.) Are at risk for self-harm determined by a licensed independent practitioner Have indications of recreational substance use determined by a urine drug test Have an abnormal lab value that may indicate major medical illness, which was not cleared by a licensed independent practitioner Have an abnormal lab value that may indicate endocrine dysfunction, which was not cleared by a licensed independent practitioner Have adrenal insufficiency determined by the ACTH stimulation test Have a current bipolar disorder determined by the SCID-IV-TR Have a current psychotic disorder determined by the SCID-IV-TR Have current alcohol dependence determined by the SCID-IV-TR Have current drug dependence determined by the SCID-IV-TR
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Jessica Gill, Ph.D.
    Organizational Affiliation
    National Institute of Nursing Research (NINR)
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Learn more about this trial

    Impact of GHRH on Sleep Promotion and Endocrine Regulation in Service Members Who Sustained a Traumatic Brain Injury and Have Current Insomnia

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