Identifying sleep targets to improve stroke outcomes

摘要 中风是美国成人残疾的主要原因，也是死亡的第二大原因 国际吧中风的影响远远超出了可见的残疾。患者报告结局（PRO）现在 被认为是卒中后结局的关键评估。重要的PRO，如疲劳，抑郁， 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， 身体健康状况较差，但对潜在的机制知之甚少。令人惊讶的是， 睡眠不足或睡眠不足对PRO的影响，包括中风后疲劳和传统的中风结局， 研究充分，但对筛查和治疗有直接影响。此应用程序代表一个辅助 研究非常成功，正在进行的大脑攻击监测科珀斯克里斯蒂（BASIC）项目（R 01 NS 38916），最近更新至2024年3月。在这项基于人群的卒中监测研究中， 在德克萨斯州的一个双民族县，对所有急性缺血性卒中患者进行了访谈，并前瞻性随访了90- 天的结果，包括一套全面的PRO。这种独特的流行病学样本，与平等的 非西班牙裔白人和墨西哥裔美国人的代表性，允许探索的影响， 睡眠中断对疲劳和中风结局的影响，特别是在墨西哥裔美国人中， 中风风险更高，中风结果更差这将通过实施国家- 最先进的全面但可行的便携式多导睡眠图和增加中风后的措施 对BASIC项目的疲劳。将多导睡眠描记法应用于我们的大型人群卒中研究 显著提高了获得中风人群中详细睡眠指标的可行性。本研究将 代表了迄今为止在卒中患者中进行的最大的完整多导睡眠图纵向研究。这些高度 翻译目标将以系统的方式检查生理洞察力和临床效用， 多导睡眠图与传统和更多患者相关卒中结局的关系。睡眠识别 与不良卒中结局相关的指标将确定卒中恢复的潜在治疗目标， 一个潜在的目标，以减少一个重要的种族健康差距。

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.