POSTOPERATIVE DELIRIUM AND ELECTROENCEPHALOGRAPHIC MEASURES OF SLEEP AND WAKEFULNESS

术后谵妄与睡眠和清醒状态的脑电图测量

• 批准号: 10374100
• 负责人: Ben Julian Palanca
• 金额: $ 30.64万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-15 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10374100
• 关键词: Acute; Address; Age-Years; Alzheimer' s Disease; Alzheimer' s disease pathology; Alzheimer' s disease related dementia; Arousal; Attention; Attenuated; Biological Markers; Cardiac; Cardiac Surgery procedures; Caregivers; Chronic; Cognitive; Complement; Complication; Consciousness Disorders; Data; Delirium; Diagnosis; Diagnostic; Disease; Elderly; Evaluation; Eye; Family; Frequencies; Future; Healthcare; Impaired cognition; Impairment; Incidence; Individual; Intervention; Manuals; Measures; Medicine; Modeling; Neurologic; Neurological outcome; Operative Surgical Procedures; Outcome; Pathologic Processes; Patients; Perioperative; Perioperative Care; Pharmacology; Phenotype; Physiological; Polysomnography; Population; Postoperative Period; Precipitating Factors; Predisposition; Procedures; Process; Prognostic Marker; Quality of Care; Recovery; Regulation; Rehabilitation therapy; Research Personnel; Risk; Risk Factors; Role; Self-Injurious Behavior; Severities; Sleep; Sleep Architecture; Sleep disturbances; Slow-Wave Sleep; Stratification; Syndrome; Testing; Thalamic structure; Therapeutic; Time; Translations; Treatment Cost; Visual; Wakefulness; Work; awake; biomarker development; cognitive function; cognitive recovery; confusion assessment method; density; design; falls; improved; inattention; insight; light weight; memory consolidation; novel; postoperative delirium; pre-clinical; predictive signature; prevent; psychologic; sleep onset; sleep quality; sleep regulation; sleep spindle; wearable device

Abstract Postoperative delirium is one of the most common complications following cardiac surgery, with an incidence of up to 50%. Apart from its psychological and physical toll on patients and caregivers, delirium interferes with rehabilitation. It places compromised individuals at risk for self-injury and falls. Given that delirium is associated with subsequent long-term cognitive impairment, elucidation of acute precipitating factors may lend insight into the chronic pathological processes underlying Alzheimer's disease and related dementias. Biomarkers are urgently needed to advance efforts aimed at characterizing postoperative delirium susceptibility, onset, and recovery. Development of these biomarkers would also serve as a major step toward clarifying pathophysiologic mechanisms. Electroencephalographic (EEG) signatures used in defining sleep architecture have potential to address these voids. Their characterization in the postoperative period is also essential for evaluating perioperative sleep disruption as a contributor and predictor of delirium. Our proposal, Postoperative Delirium and Electroencephalographic Measures of Sleep and Wakefulness, is designed to probe temporal relationships between delirium and well-characterized EEG signatures that predict cognitive dysfunction. Future preoperative stratification for delirium vulnerability could inform patients and their families regarding the likelihood of potential cognitive trajectories after elective procedures. For health care practitioners, identification of susceptible patients before surgery could focus diagnostics and optimization. The proposed work may also contribute to novel pharmacologic and non-pharmacologic interventions. Such therapies would target underlying thalamocortical circuits and the expression of specific EEG motifs to impact cognitive recovery. Overall, we expect this work to yield inexpensive, noninvasive, and readily translatable biomarkers, thereby improving neurological outcomes within and beyond perioperative medicine.

摘要 术后谵妄是心脏手术后最常见的并发症之一， 高达50%。除了对患者和护理人员造成心理和身体上的损失外，谵妄还干扰了 康复活动.它使受影响的人处于自伤和福尔斯的危险之中。考虑到精神错乱与 对于随后的长期认知障碍，急性诱发因素的阐明可能有助于了解 阿尔茨海默病和相关痴呆症的慢性病理过程。生物标志物 迫切需要推进旨在表征术后谵妄易感性、发作和 复苏这些生物标志物的开发也将成为澄清 病理生理机制用于定义睡眠结构的脑电图（EEG）特征 有可能解决这些问题。他们在术后时期的特征也是必不可少的， 评估围手术期睡眠中断作为谵妄的贡献者和预测因子。我们的建议，术后 谵妄和睡眠和觉醒的脑电图测量，旨在探索时间 谵妄与预测认知功能障碍的特征明确的EEG特征之间的关系。 未来对谵妄易感性的术前分层可以告知患者及其家属关于 择期手术后潜在认知轨迹的可能性。对于卫生保健从业人员， 对易感患者的术前诊断可以集中诊断和优化。拟议的工作还可 有助于新的药理学和非药理学干预。这些疗法将针对 潜在的丘脑皮层回路和特定EEG图案的表达影响认知恢复。 总的来说，我们希望这项工作能够产生廉价，非侵入性和易于翻译的生物标志物，从而 改善围手术期医学内外的神经学结局。

项目成果

In Response.

在回应中。

• DOI: 10.1097/mcg.0000000000000451
• 发表时间: 2016
• 期刊: Journal of clinical gastroenterology
• 影响因子: 2.9
• 作者: Dasarathy,Srinivasan;Dasarathy,Jaividhya;Khiyami,Amer;Yerian,Lisa;McCullough,ArthurJ
• 通讯作者: McCullough,ArthurJ

Associations of environmental and lifestyle factors with spatial navigation in younger and older adults.

• DOI: 10.1017/s1355617722000303
• 发表时间: 2023-05
• 期刊: JOURNAL OF THE INTERNATIONAL NEUROPSYCHOLOGICAL SOCIETY
• 影响因子: 2.6
• 作者: Maybrier, Hannah;Palanca, Ben Julian A.;Head, Denise
• 通讯作者: Head, Denise

American Delirium Society 2022 Year in Review: Highlighting the Year's Most Impactful Delirium Research.

• DOI: 10.56392/001c.73356
• 发表时间: 2023-03
• 期刊: Delirium communications
• 作者: C. A. Austin;B. Palanca;Kendall Smith;Benjamin Chapin;Shih-Yin Lin;S. Khan;H. Lindroth;Kerri Maya;Mark A. Oldham

Pro-Con Debate: Electroencephalography-Guided Anesthesia for Reducing Postoperative Delirium.

赞成与反对的争论：脑电图引导麻醉减少术后谵妄。

• DOI: 10.1213/ane.0000000000006399
• 发表时间: 2023
• 期刊: Anesthesia and analgesia
• 影响因子: 5.7
• 作者: Hao,David;Fritz,BradleyA;Saddawi-Konefka,Daniel;Palanca,BenJulianA
• 通讯作者: Palanca,BenJulianA

Protocol for the Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography (P-DROWS-E) study: a prospective observational study of delirium in elderly cardiac surgical patients.

• DOI: 10.1136/bmjopen-2020-044295
• 发表时间: 2020-12-13
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Smith SK;Nguyen T;Labonte AK;Kafashan M;Hyche O;Guay CS;Wilson E;Chan CW;Luong A;Hickman LB;Fritz BA;Emmert D;Graetz TJ;Melby SJ;Lucey BP;Ju YS;Wildes TS;Avidan MS;Palanca BJA
• 通讯作者: Palanca BJA