Sleep Quality and Cognitive Function in Hospitalized Older Adult Survivors of Critical Illness

危重病住院老年幸存者的睡眠质量和认知功能

• 批准号: 9759121
• 负责人: Maya Elias
• 金额: $ 6.53万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9759121
• 关键词: Address; Adult; Age; Alzheimer' s Disease; Area; Arousal; Attention; Biological; Caring; Circadian Rhythms; Clinical; Cognition; Cognitive; Communities; Critical Care; Critical Illness; Data; Data Analyses; Development; Dimensions; Drowsiness; Elderly; Environment; Ethnic Origin; Geriatrics; Goals; Hispanics; Home environment; Hospitalization; Hospitals; Hour; Impaired cognition; Incidence; Intensive Care Units; Intervention; Latino; Light; Link; Long-Term Care; Measures; Mechanical ventilation; Mechanics; Mentorship; Minority; Motion; Neurobehavioral Manifestations; Neurocognitive; Neuropsychology; Nurses; Obstructive Sleep Apnea; Older Population; Outcome; Patients; Polysomnography; Population; Prevalence; Race; Recording of previous events; Recovery; Research; Risk; Risk Factors; Scientist; Short-Term Memory; Skilled Nursing Facilities; Sleep; Sleep Architecture; Sleep Deprivation; Sleep Fragmentations; Sorting - Cell Movement; Survivors; Symptoms; Syndrome; Testing; Time; Training; Training Programs; Traumatic Brain Injury; United States; United States National Institutes of Health; Work; actigraphy; adequate sleep; base; career; circadian; cognitive function; cognitive performance; design; executive function; experience; healthy aging; high risk population; human old age (65+); longitudinal design; metropolitan; modifiable risk; nursing intervention; prevent; sex; sleep abnormalities; sleep quality; survivorship; symptom management; symptom science; therapy design

Project Summary/Abstract Almost 25% of intensive care unit (ICU) survivors experience post-ICU cognitive impairment comparable to that of mild Alzheimer’s disease; about 33% suffer from cognitive impairment equivalent to moderate traumatic brain injury. Critically ill older adults (ages 65 and older) have the highest incidence of mechanical ventilation and are at most risk for post-ICU cognitive impairment. Mechanically ventilated ICU patients experience worse sleep than those who are not ventilated. The proposed research focuses on older adult ICU survivors who required mechanical ventilation for survival. The scientific premises are: 1) sleep deficiency may be associated with post-ICU syndrome and cognitive impairment, and 2) sleep may be a modifiable risk factor to prevent post-ICU cognitive impairment. Understanding sleep deficiency is essential to design personalized symptom management interventions to prevent post-ICU cognitive decline. This is the first study to evaluate the longitudinal effect of sleep deficiency on post-ICU cognitive impairment among older adult ICU survivors. Specific Aim 1 is to determine the daytime and nighttime sleep quality (sleep architecture and sleep environment) of older adult ICU survivors who required mechanical ventilation while in ICU. Sleep (i.e., polysomnography and actigraphy) will be measured at time of transfer out of ICU, and again at 1 and 3 months post-hospital discharge. Polysomnography will describe sleep architecture (sleep duration, efficiency, fragmentation, and latency; N1, N2, N3, and REM stages; and cortical and sympathetic arousals). Actigraphy will describe sleep environment (ambient light/dark levels and motion/inactivity). Specific Aim 2 is to determine the effect size of the longitudinal relationship between sleep deficiency and post-ICU cognitive impairment. Cognitive function (i.e., executive function and working memory) will be assessed at time of transfer out of ICU, and again at 1 and 3 months post-hospital discharge, using selected measures from the NIH Toolbox Cognition Battery. Additional related data (biological variables including age, sex, race/ethnicity, and clinical history such as obstructive sleep apnea) will be collected to explore risk factors for sleep deficiency and post- ICU cognitive impairment. Data will provide direction on development of nursing interventions (e.g., promoting sleep consolidation, restructuring sleep environment, reestablishing circadian rhythm, decreasing daytime sleepiness) to best target and prevent post-ICU cognitive impairment. The proposed research will take place in one of the largest “minority-majority” metropolitan areas in the United States—65% of Miami’s population is Hispanic/Latino. The proposed project will support the applicant in her career goal to develop her professional identity as a nurse scientist, with an individualized, rigorous training program of symptom science research and longitudinal data analysis centered on geriatrics, sleep, cognitive neuropsychology, and critical care. The proposed training plan integrates the scientific and analytic expertise of an interdisciplinary mentorship team.

项目总结/摘要 近25%的重症监护室（ICU）幸存者经历ICU后认知障碍 与轻度阿尔茨海默病相当;约33%患有相当于 中度脑外伤重症老年人（65岁及以上）的发病率最高， 机械通气和ICU后认知障碍的风险最大。机械通气ICU 患者的睡眠比不通气的患者更差。研究重点是老年人 需要机械通气才能生存的成年ICU幸存者。科学的前提是：1）睡眠 缺乏可能与ICU后综合征和认知障碍有关，2）睡眠可能是一种 可改变的风险因素，以防止ICU后认知障碍。了解睡眠不足是必不可少的， 设计个性化的症状管理干预措施，以防止ICU后认知功能下降。这是第一 一项评估睡眠不足对老年人ICU后认知障碍的纵向影响的研究 重症监护室的成年幸存者具体目标1是确定白天和夜间的睡眠质量（睡眠结构 和睡眠环境）的老年ICU幸存者谁需要机械通气，而在ICU。睡眠 (i.e.,多导睡眠描记术和体动描记术）将在转出ICU时测量，并在1和3时再次测量 出院后数月。多导睡眠图将描述睡眠结构（睡眠持续时间，效率， 片段和潜伏期; N1、N2、N3和REM阶段;以及皮层和交感神经唤醒）。活动记录 将描述睡眠环境（环境光/暗水平和运动/不活动）。具体目标2是确定 睡眠不足与ICU后认知功能障碍之间纵向关系的效应量。 认知功能（即，执行功能和工作记忆）将在转出ICU时进行评估， 并在出院后1个月和3个月再次使用来自NIH研究的选定指标， 认知电池其他相关数据（生物学变量，包括年龄、性别、人种/种族和临床 病史，如阻塞性睡眠呼吸暂停）将被收集，以探索睡眠不足的风险因素， ICU认知障碍数据将为护理干预措施的制定提供指导（例如，促进 睡眠巩固，重建睡眠环境，重建昼夜节律，减少白天 嗜睡），以最好的目标和预防ICU后认知障碍。拟议的研究将在 美国最大的“少数民族占多数”的大都市区之一--迈阿密65%的人口是 西班牙裔/拉丁裔。建议的项目将支持申请人在她的职业目标，发展她的专业 作为一名护理科学家的身份，具有个性化，严格的症状科学研究培训计划， 纵向数据分析集中在老年病学、睡眠、认知神经心理学和重症监护。的 拟议的培训计划整合了一个跨学科导师团队的科学和分析专长。