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

此辅助R01的目标是评估中风或短暂性脑缺血后的睡眠和久坐行为 短暂性脑缺血发作(TIA)是降低继发性心血管疾病(CVD)风险的潜在治疗目标。我们会 还要确定中风/短暂性脑缺血发作后睡眠不良和久坐行为的可修改预测因素，以指导早期 干预努力。在美国，中风是导致长期严重残疾的主要原因，有近100万人 每年住院(每40秒约1人)。治疗急性胰腺炎的新技术和新药物 中风/短暂性脑缺血发作确保大多数患者存活，但在一年内，四分之一的幸存者将死亡或复发 CVD事件。因此，确定新的二级预防目标至关重要。来自大量的证据 观察性队列研究和以实验室为基础的机械实验表明两者之间存在联系 睡眠时间短或长，久坐不动会增加心血管疾病发生和复发的风险 发病率和死亡率。中风幸存者尤其有可能经历睡眠时间短和高睡眠 住院后大量的久坐不动。现有的二级预防指南中没有提到睡眠 或久坐行为是中风幸存者的目标风险因素。要影响指南，研究必须 确定客观测量的睡眠时间和久坐行为是否与增加 卒中后的发病率/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 各种因素可能相互作用，增加中风后复发和死亡风险。因此，我们将进行一项 全面和客观地评估总体24小时行为活动概况，以调查 睡眠不良和久坐行为对中风复发/死亡率的独立和共同作用。这个 目前的父母研究是对到急诊室就诊的中风/短暂性脑缺血发作患者进行的纵向队列研究 并追踪一年以确定(1)中风引起的创伤后应激障碍(PTSD)的预测因素 以及(2)卒中诱发的创伤后应激障碍是否是复发心血管事件和死亡率的危险因素。在这份附属文件中 我们计划使用三轴腕部加速度计来客观地测量睡眠和久坐行为 在父母研究中登记的1016名患者在出院后45天。我们还将在登记时对患者进行调查 并进行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时间和久坐时间 在卒中/短暂性脑缺血发作幸存者中，行为与1年复发事件/死亡率相关。如果这些 行为解释了心血管事件复发和死亡的大部分额外风险，我们将 有针对这些行为的基础，以降低这一患者群体的二次风险。发现 将提供新的干预措施，通过以下方式改善中风幸存者的睡眠和减少久坐行为(1) 确定为什么中风幸存者容易睡眠不佳和久坐不动，以及(2)提供 以确定的预测因素为目标的新战略，以改善这些可修改的结果。

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.