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Poor Sleep, Sedentary Behavior, and Secondary Cardiovascular Risk in Stroke and TIA Patients.

中风和 TIA 患者的睡眠不良、久坐行为和继发性心血管风险。

基本信息

批准号：
10378132
负责人：
Ari Shechter
金额：
$ 66.3万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-05-04 至 2024-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10378132
关键词：
Accelerometer Accident and Emergency department Admission activity Behavior Behavioral Cardiovascular Diseases Cardiovascular system Cause of Death Cessation of life Cohort Studies Data Early Intervention Enrollment Ensure Event Fatigue Foundations Fright Goals Guidelines Health behavior Hospitalization Hour Individual Inpatients Intervention Joints Laboratories Light Link Longitudinal cohort study Measures Morbidity - disease rate Myocardial Infarction Obstructive Sleep Apnea Outcome Parents Patients Persons Pharmaceutical Preparations Physical activity Post-Traumatic Stress Disorders Prevention Guidelines Prognosis Public Health Recurrence Research Risk Risk Factors Risk Reduction Secondary Prevention Severities Sleep Stroke Surveys Survivors Time Transient Ischemic Attack Unstable angina Wrist acute coronary syndrome acute stroke base cardiometabolism cardiovascular disorder risk cardiovascular risk factor cerebrovascular disability experience experimental study follow-up improved moderate-to-vigorous physical activity modifiable behavior mortality mortality risk new technology novel novel strategies patient population poor sleep post stroke prognostic public health priorities sedentary sedentary lifestyle sleep behavior stroke survivor therapeutic target

项目摘要

The goal of this ancillary R01 is to evaluate sleep and sedentary behavior after stroke or transient ischemic attack (TIA) as potential therapeutic targets to reduce risk of secondary cardiovascular disease (CVD). We will also identify modifiable predictors of poor sleep and sedentary behavior post-stroke/TIA to guide early intervention efforts. Stroke is the leading cause of serious long-term disability in the U.S., with nearly 1 million inpatient admissions per year (~1 person every 40 sec). New technologies and medications for acute stroke/TIA ensure that most patients survive, but within 1 year, 1 in 4 survivors will die or have a recurrent CVD event. Identification of novel secondary prevention targets is thus vitally important. Evidence from large observational cohort studies and laboratory-based mechanistic experiments have indicated a link between both poor sleep duration (short or long) and sedentary behavior with increased risk for incident and recurrent CVD morbidity and mortality. Stroke survivors are particularly likely to experience poor sleep duration and high volumes of sedentariness after hospitalization. No existing guidelines for secondary prevention mention sleep or sedentary behavior as risk factors to target in stroke survivors. To influence guidelines, research must determine whether objectively-measured sleep duration and sedentary behavior are associated with increased morbidity/mortality risk post-stroke. It is also important to understand whether, and how, these emerging risk factors may interact to increase post-stroke recurrence and mortality risk. We will therefore conduct a comprehensive and objective assessment of the overall 24-h behavioral activity profile to investigate the independent and joint contributions of poor sleep and sedentary behavior to stroke recurrence/mortality. The current parent study is a longitudinal cohort study of stroke/TIA patients who present to the emergency room and are followed for 1 year to determine (1) predictors of stroke-induced post-traumatic stress disorder (PTSD) and (2) whether stroke-induced PTSD is a risk factor for recurrent CVD events and mortality. In this ancillary project we propose to use triaxial wrist-accelerometers to measure sleep and sedentary behavior objectively for 45 days post-discharge in 1,016 patients enrolled in the parent study. We will also survey patients at enrollment and 1-month follow-up to identify predictors of poor sleep and sedentary behavior post-discharge. These findings will be used to primarily evaluate whether objectively-measured sleep duration and sedentary behavior are associated with risk of 1-year recurrent events/mortality in stroke/TIA survivors. If these behaviors explain a substantial portion of excess risk for recurrent cardiovascular events and mortality, we will have a foundation to target these behaviors for secondary risk reduction in this patient population. Findings will inform novel interventions to improve sleep and reduce sedentary behavior among stroke survivors by (1) determining why stroke survivors are prone to poor sleep and high volumes of sedentariness and (2) offering novel strategies targeting identified predictors to improve these modifiable outcomes.

本辅助R 01的目标是评估卒中或短暂性脑缺血后的睡眠和久坐行为 TIA发作（TIA）作为潜在的治疗靶点，以降低继发性心血管疾病（CVD）的风险。我们将还确定了中风/TIA后睡眠不良和久坐行为的可修改预测因素，干预努力。在美国，中风是导致严重长期残疾的主要原因，近100万人每年住院人数（约每40秒1人）。新技术和药物治疗急性中风/短暂性脑缺血发作确保了大多数患者的生存，但在1年内，每4名幸存者中就有1人死亡或复发。 CVD事件。因此，确定新的二级预防目标至关重要。证据来自大型观察性队列研究和基于实验室的机制实验表明，睡眠时间短或长，久坐不动，增加CVD事件和复发的风险发病率和死亡率。中风幸存者特别有可能经历睡眠时间不长和高血压。住院后久坐不动的数量。现有的二级预防指南没有提到睡眠或久坐不动的行为作为中风幸存者的危险因素。为了影响指导方针，研究必须确定客观测量的睡眠持续时间和久坐行为是否与增加的卒中后发病率/死亡率风险。同样重要的是要了解这些新出现的风险是否以及如何这些因素可能相互作用，增加中风后复发和死亡的风险。因此，我们将进行全面和客观的评估整体24小时行为活动概况，以调查睡眠不良和久坐行为对卒中复发/死亡率的独立和联合作用。的目前的母研究是一项对急诊室就诊的卒中/TIA患者的纵向队列研究并随访1年，以确定（1）中风引起的创伤后应激障碍（PTSD）的预测因子以及（2）卒中诱发的PTSD是否是CVD事件复发和死亡的危险因素。在这个辅助我们建议使用三轴腕部加速度计来客观地测量睡眠和久坐行为，入组母研究的1，016例患者出院后45天。我们还将在入组时调查患者和1个月的随访，以确定出院后睡眠不良和久坐行为的预测因素。这些研究结果将主要用于评估客观测量的睡眠持续时间和久坐不动是否行为与卒中/TIA幸存者1年复发事件/死亡风险相关。如果这些行为解释了心血管事件复发和死亡的大部分过度风险，我们将有一个基础，以针对这些行为的二次风险降低在这个病人群体。结果将通过以下方式为改善中风幸存者的睡眠和减少久坐行为提供新的干预措施：确定为什么中风幸存者容易睡眠不好和久坐不动，以及（2）提供新的战略目标确定的预测，以改善这些可改变的结果。