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

Traumatic Brain Injury Clinical Trial

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

Status Withdrawn

Clinical Trial 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.

Clinical Trial 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. ;

Related Conditions & MeSH terms

• Brain Injuries
• Brain Injuries, Traumatic
• Sleep Disorder
• Sleep Initiation and Maintenance Disorders
• Sleep Wake Disorders
• Traumatic Brain Injury
• Wounds and Injuries

• NCT number: NCT02931474
• Study type: Interventional
• Source: National Institutes of Health Clinical Center (CC)
• Status: Withdrawn
• Phase: Phase 2
• Start date: October 6, 2016
• Completion date: March 8, 2017