Pediatric Asthma Disparities: The Role of Sleep and Immune Balance

小儿哮喘差异：睡眠和免疫平衡的作用

• 批准号: 9207483
• 负责人: Daphne Koinis Mitchell
• 金额: $ 10.15万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-02-01 至 2021-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9207483
• 关键词: 10 year old; Address; Adherence; Adult; Affect; Age; Area; Asthma; Beds; Behavior; Behavior Therapy; Behavior assessment; Biological; Biological Markers; Caregivers; Child; Childhood; Childhood Asthma; Chronic; Clinical; Clinical Immunology; Crowding; Data; Development; Disease; Drowsiness; Eligibility Determination; Equilibrium; Ethics; Evaluation; Experimental Designs; Extrinsic asthma; Faculty; Fellowship Program; Funding; Goals; Grant; Growth and Development function; Home environment; Human; Immune; Immunologic Markers; Inflammation; Inflammatory; Interferon-alpha; Interleukin-13; Interleukin-4; Interleukin-5; Interleukin-6; Interleukins; Intervention; Intervention Studies; Investigation; K-Series Research Career Programs; Knowledge; Link; Longitudinal Studies; Mentors; Mentorship; Methods; Minority; Nocturnal Asthma; Outcome; Performance; Physiology; Plasma; Polysomnography; Postdoctoral Fellow; Process; Protocols documentation; Psychiatry; Pulmonary Function Test/Forced Expiratory Volume 1; Recording of previous events; Recruitment Activity; Reporting; Research; Research Design; Research Infrastructure; Research Project Grants; Resources; Respiratory physiology; Risk; Role; Schedule; Schools; Sleep; Sleep Fragmentations; Sleep disturbances; Spirometry; Symptoms; Testing; Time; Training; Training Activity; Universities; Work; actigraphy; base; career; cytokine; elementary school; ethnic diversity; health disparity; improved; innovation; interest; medical schools; mid-career faculty; minority children; patient oriented research; phenomenological models; primary caregiver; programs; public health relevance; statistics; training opportunity; treatment response; urban children; urban poverty; vigilance

 DESCRIPTION (provided by applicant): This K24 application proposes a mentorship program in patient-oriented research in multi-level contributors to pediatric asthma health disparities, wih a focus on sleep and immune balance. The K24 Candidate is an Associate Professor (Research) in the Department of Psychiatry and Human Behavior of the Warren Alpert Medical School at Brown University, with a history of funding in behavioral interventions and longitudinal research aimed at improving asthma outcomes in urban children and addressing health disparities in pediatric asthma. Training Plan: The candidate will obtain additional training in asthma clinical immunology and sleep physiology, including state-of the art methods to assess immune biomarkers relevant to asthma and sleep, and in-lab methods to assess sleep phenomenology through experimental approaches. Research Plan: The research proposed involves an innovative investigation of the effects of experimental sleep disruption on immune balance (Th1/Th2 cytokine ratio-Th1/Th2R; plasma IL-6 -pIL-6), and associated changes in asthma- related lung function (FEV1 by spirometry) and daytime performance in urban children with persistent asthma (8-10 years old). Forty children and their primary caregiver will each participate in a within-subjects protocol, with two experimental sleep conditions: baseline sleep (1 overnight, in-lab polysomnographic (PSG) sleep study), followed by sleep fragmentation (1 overnight, in-lab PSG). Prior to each condition, children will follow a 6-day sleep stabilization schedule at home. We will monitor sleep and lung function (FEV1 by spirometry) daily to confirm eligibility and adherence to sleep criteria, and assess asthma status. We include assessments of immune biomarkers and daytime performance following each condition. Results from this study ultimately will support the development of asthma and sleep interventions for urban and ethnically diverse children. Our data will elucidate how immune biomarkers relevant to asthma and sleep operate in relation to sleep disruption, and clinical indicators of worsening asthma (lung function), to identify those most at risk, prioritize intervention targets, and improve treatment response. Mentoring Plan: The proposed mentoring plan offers opportunities for mentorship of postdoctoral fellows, residents and junior faculty with interests in POR. Mentees will be involved in ongoing longitudinal and intervention studies on pediatric asthma disparities, including the proposed research, which will focus on biological-based processes that contribute to asthma and sleep in urban children. A strong emphasis is placed on the recruitment and selection of minority mentees. This overall plan capitalizes on the rich resources and training opportunities available to postdoctoral fellows, residents and junior faculty at Brown Medical School, including several T32 fellowship programs, numerous junior faculty with K awards and small grants, a commitment to diversity in training, seminars in research design, ethics, and statistics, and an established infrastructure for evaluation.

 描述（由申请人提供）：本 K24 申请提出了一项以患者为导向的研究指导计划，针对儿童哮喘健康差异的多层次贡献者，重点关注睡眠和免疫平衡。 K24 候选人是布朗大学沃伦阿尔珀特医学院精神病学和人类行为系的副教授（研究），曾资助行为干预和纵向研究，旨在改善城市儿童的哮喘结果并解决小儿哮喘的健康差异。培训计划：候选人将获得哮喘临床免疫学和睡眠生理学方面的额外培训，包括评估与哮喘和睡眠相关的免疫生物标志物的最先进方法，以及通过实验方法评估睡眠现象学的实验室方法。研究计划：拟议的研究涉及一项创新性调查，研究实验性睡眠中断对免疫平衡（Th1/Th2 细胞因子比值 -Th1/Th2R；血浆 IL-6 -pIL-6）的影响，以及哮喘相关肺功能（肺活量测定的 FEV1）和城市持续性哮喘儿童（8-10 岁）白天表现的相关变化。 40 名儿童及其主要照顾者将各自参与受试者内部方案，其中有两种实验睡眠条件：基线睡眠（1 晚，实验室内多导睡眠图 (PSG) 睡眠研究），然后是睡眠碎片（1 晚，实验室内 PSG）。在出现每种情况之前，孩子们将在家遵循 6 天的睡眠稳定计划。我们将每天监测睡眠和肺​​功能（通过肺活量测定法测定 FEV1），以确认资格和遵守睡眠标准，并评估哮喘状况。我们对每种情况下的免疫生物标志物和日间表现进行评估。这项研究的结果最终将支持城市和种族不同儿童的哮喘和睡眠干预措施的发展。我们的数据将阐明与哮喘和睡眠相关的免疫生物标志物如何与睡眠中断以及哮喘恶化的临床指标（肺功能）相关，从而识别高危人群、优先考虑干预目标并改善治疗反应。指导计划：拟议的指导计划为对 POR 感兴趣的博士后研究员、住院医生和初级教师提供指导机会。学员将参与正在进行的关于儿科哮喘差异的纵向和干预研究，包括拟议的研究，该研究将重点关注导致城市儿童哮喘和睡眠的生物过程。非常重视少数族裔学员的招募和选拔。该总体计划利用了布朗医学院为博士后研究员、住院医师和初级教师提供的丰富资源和培训机会，包括多个 T32 奖学金计划、众多获得 K 奖和小额赠款的初级教师、对培训多样性的承诺、研究设计、伦理和统计方面的研讨会以及已建立的评估基础设施。