Identifying sleep targets to improve stroke outcomes

确定睡眠目标以改善中风结果

• 批准号: 10222779
• 负责人: DEVIN L BROWN
• 金额: $ 39万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10222779
• 关键词: Acute; Adult; Affect; Ancillary Study; Chronic; Clinical; Cognitive; Consequentialism; County; Epidemiology; Fatigue; High Prevalence; Inflammation; Infrastructure; Interview; Investigation; Ischemic Stroke; Longitudinal Studies; Measurement; Measures; Mediating; Mental Depression; Mexican Americans; Not Hispanic or Latino; Outcome; Outcome Measure; Pain; Parents; Patient Care; Patient Outcomes Assessments; Patients; Physiological; Polysomnography; Population; Population Study; Rehabilitation therapy; Sampling; Sleep; Sleep Apnea Syndromes; Sleep Architecture; Sleep Deprivation; Sleep Disorders; Sleep disturbances; Slow-Wave Sleep; Stroke; Subgroup; Time; United States; Wakefulness; acute stroke; care burden; caucasian American; disability; ethnic difference; ethnic health disparity; experience; improved; insight; mortality; neural network; novel; physical conditioning; poor sleep; population based; portability; post stroke; prospective; repaired; screening; sleep onset; stroke outcome; stroke patient; stroke recovery; stroke rehabilitation; stroke risk; stroke survivor; surveillance study; translational impact

Abstract Stroke is the leading cause of adult disability in the United States and the second leading cause of mortality worldwide. The impact of stroke goes well beyond visible disability. Patient-reported outcomes (PROs) are now recognized as critical assessments of post-stroke outcomes. Important PROs such as fatigue, depression, and pain affect approximately half of stroke survivors and predict post-stroke disability, higher burden of care, and worse physical health but the underlying mechanisms are poorly understood. Surprisingly, the contributions of poor or inadequate sleep to PROs including post-stroke fatigue and traditional stroke outcomes have not been well-studied but have direct implications for screening and treatment. This application represents an ancillary study to the highly successful, ongoing Brain Attack Surveillance in Corpus Christi (BASIC) Project (R01 NS38916), recently renewed through March 2024. In this population-based stroke surveillance study within a Texan bi-ethnic county, all acute ischemic stroke patients are interviewed and followed prospectively for 90- day outcomes, including a comprehensive set of PROs. This unique epidemiologic sample, with equal representation of non-Hispanic whites and Mexican Americans, allows for the exploration of effects of disrupted sleep on fatigue and stroke outcomes in general and specifically in Mexican Americans, a subgroup with higher stroke risk and worse stroke outcomes. This will be accomplished through application of state-of- the-art comprehensive but feasible portable polysomnography and the addition of measures of post-stroke fatigue to the BASIC Project. Incorporating polysomnography into our large, population-based stroke study significantly enhances the feasibility to obtain detailed sleep metrics in the stroke population. This study will represent the largest longitudinal study to-date of full polysomnography among stroke patients. These highly translational aims will examine in a systematic manner the physiologic insight and clinical utility provided by polysomnography in relation to traditional and more patient-relevant stroke outcomes. Identification of sleep measures associated with poor stroke outcomes will identify potential treatment targets for stroke recovery and a potential target to reduce an important ethnic health disparity.

抽象的 中风是美国成人残疾的主要原因，也是死亡的第二大原因 全世界。中风的影响远远超出了可见的残疾范围。患者报告结果 (PRO) 现已 被认为是中风后结果的关键评估。重要的 PRO，例如疲劳、抑郁和 疼痛影响大约一半的中风幸存者，并预测中风后残疾、更高的护理负担以及 身体健康状况恶化，但其潜在机制却知之甚少。令人惊讶的是， PRO 的睡眠质量不佳或不足，包括中风后疲劳和传统的中风结果尚未得到解决 经过充分研究，但对筛查和治疗有直接影响。该应用程序代表一个辅助 对科珀斯克里斯蒂 (BASIC) 项目（R01）非常成功、正在进行的脑攻击监测的研究 NS38916），最近更新至 2024 年 3 月。在这项基于人群的中风监测研究中， 德克萨斯州双种族县，所有急性缺血性中风患者均接受访谈并前瞻性随访 90- 日结果，包括一套全面的 PRO。这种独特的流行病学样本具有同等的 非西班牙裔白人和墨西哥裔美国人的代表，允许探索 睡眠中断对疲劳和中风结果的影响总体而言，尤其是墨西哥裔美国人（一个亚群体） 中风风险更高，中风结果更差。这将通过应用 State-of- 最先进的全面但可行的便携式多导睡眠图和中风后措施的补充 对 BASIC 项目的疲劳。将多导睡眠图纳入我们基于人群的大型卒中研究 显着提高了获得中风人群详细睡眠指标的可行性。这项研究将 这是迄今为止针对中风患者进行全面多导睡眠监测的最大纵向研究。这些高度 转化目标将以系统的方式检查生理学见解和临床实用性 多导睡眠图与传统的和更与患者相关的卒中结果的关系。睡眠识别 与不良中风结果相关的措施将确定中风康复的潜在治疗目标 减少重要的种族健康差距的潜在目标。