Sleep Management And Recovery after Traumatic Brain Injury in Kids (SMART-Kids): Evidence for targeting sleep to improve outcomes

项目摘要 睡眠对儿童大脑的成熟和发育以及损伤后的神经元愈合都是至关重要的。 创伤性脑损伤是一种常见的儿科危重疾病，每年影响超过5万名儿童， 其中一半人患有急性和慢性睡眠觉醒障碍(SWD)，导致生活质量下降。这些 儿童在受伤后多年也会遭受严重的认知障碍，特别是在 执行功能，导致学习成绩下降和心理社会功能障碍。是否入睡 在脑外伤仍然未知之后，干扰显著地加剧了这些认知缺陷。此外，有效的 预防或改善这些弱势儿童中的SWD和执行功能障碍的治疗方法如下 缺乏。这项建议的中心假设是，社署是一项独立和可更改的风险因素 脑外伤后存活儿童的执行功能损害。拟议研究的目标是：1) 确定儿童颅脑损伤后SWD与执行功能的纵向关联 使用问卷和客观措施进行前瞻性队列研究，2)评估可行性和 住院期间开始的早期褪黑素和睡眠管理干预的有效性 单中心随机对照试验。 塞德尼·威廉姆斯博士是俄勒冈健康与科学大学的儿科重症监护内科医生。 在儿科重症监护室和在重症监护室纵向护理危重儿童 后续诊所。她的研究表明，社会福利署是影响一半以上重症监护的重要病症 幸存者，特别是在她跟踪的大量TBI幸存者中。她的长期目标是改进 通过严格的研究确定有效的干预措施来改善纵向结果和生活质量 通过首先评估脑外伤幸存者的高危队列，研究儿童重症监护后的睡眠障碍。这 职业发展提案将为威廉姆斯博士提供指导睡眠的经验和指导培训 研究、临床试验方法和纵向数据分析。这项建议意义重大，因为它 解决影响数以千计的儿童创伤性脑损伤幸存者的常见和令人衰弱的SWD发病率 每年，通过测试早期睡眠管理干预措施来推进临床护理和研究，以及 与美国国立卫生研究院睡眠障碍研究计划相一致。这项研究和多年来 学科指导培训将为威廉姆斯博士提供所需的数据和研究专业知识 独立研究经费用于评估儿童脑外伤和其他危重疾病幸存者的社会功能障碍。

Project Summary Sleep is critical for brain maturation and development in childhood, and for neuronal healing after injury. Traumatic brain injury (TBI) is a common pediatric critical illness affecting more than 50,000 children annually, half of whom suffer acute and chronic sleep wake disturbances (SWD) leading to impaired quality of life. These children also suffer substantial cognitive impairments for many years after injury, particularly in domains of executive function, leading to reduced academic performance and psychosocial dysfunction. Whether sleep disturbances significantly compound these cognitive deficits after TBI remains unknown. Additionally, effective therapies shown to prevent or improve SWD and executive dysfunction among these vulnerable children are lacking. The central hypothesis of this proposal is that SWD are an independent and modifiable risk factor for executive function impairment in children surviving TBI. The objectives of the proposed research are to: 1) Determine the longitudinal association between SWD and executive function after pediatric TBI in a prospective cohort study using both questionnaires and objective measures, 2) Evaluate feasibility and effectiveness of an early melatonin and sleep management intervention started during hospitalization in a single-center randomized controlled trial. Dr. Cydni Williams is a Pediatric Critical Care physician at Oregon Health & Science University where she cares for critically ill children acutely in the pediatric intensive care unit and longitudinally in a critical care follow-up clinic. Her work has identified SWD as an important morbidity affecting more than half of critical care survivors, particularly in the large number of TBI survivors she follows. Her long-term goal is to improve longitudinal outcomes and quality of life through rigorous studies identifying effective interventions to improve sleep disturbances after pediatric critical care, by first evaluating the high risk cohort of TBI survivors. This career development proposal will provide Dr. Williams with experiential and mentored training conducting sleep research, clinical trial methodology, and longitudinal data analyses. This proposal is significant because it addresses the common and debilitating morbidity of SWD that affect thousands of pediatric TBI survivors annually, advances clinical care and research through testing an early sleep management intervention, and aligns with the National Institutes of Health Sleep Disorders Research Plan. This research and multi- disciplinary mentored training will provide Dr. Williams with data and research expertise needed to pursue independent research funding to evaluate SWD in pediatric TBI and other critical illness survivors.