Identifying sleep targets to improve stroke outcomes

摘要 中风是美国成年人致残的首要原因，也是导致死亡的第二大原因 全世界。中风的影响远远超出了看得见的残疾。患者报告的结果(PRO)现在是 被认为是对中风后预后的关键评估。重要的优点，如疲劳、抑郁和 疼痛影响了大约一半的中风幸存者，并预示着中风后的残疾、更高的护理负担和 身体健康状况更差，但其潜在机制却鲜为人知。令人惊讶的是， 专业人士睡眠不佳或不足，包括中风后疲劳和传统的中风结果 研究充分，但对筛查和治疗有直接影响。此应用程序代表一个辅助 对语料库Christi(BASIC)项目(R01)中成功的、持续的脑攻击监测的研究 NS38916)，最近续签至2024年3月。在这项以人群为基础的中风监测研究中 德克萨斯双族县，所有急性缺血性中风患者都接受了访谈，并前瞻性地随访了90- 一天的结果，包括一套全面的专业知识。这一独特的流行病学样本，与 非西班牙裔白人和墨西哥裔美国人的代表，允许探索 睡眠中断对疲劳和中风结果的影响，特别是墨西哥裔美国人，这是一个亚组 有更高的中风风险和更差的中风结果。这将通过以下方式实现： 技术全面但可行的便携式多导睡眠图和增加中风后的测量 对基础项目的疲惫。将多导睡眠图纳入我们基于人群的大规模卒中研究中 显著提高了在中风人群中获得详细睡眠指标的可行性。这项研究将 是迄今为止在中风患者中进行的最大规模的全息睡眠监测纵向研究。这些高度 翻译目标将以系统的方式检查由 多导睡眠监测与传统和更多与患者相关的卒中结果的关系。睡眠识别 与不良卒中结局相关的措施将确定卒中恢复和恢复的潜在治疗目标 这是缩小一个重要的种族健康差距的潜在目标。

Abstract Stroke is the leading cause of adult disability in the United States and the second leading cause of mortality worldwide. The impact of stroke goes well beyond visible disability. Patient-reported outcomes (PROs) are now recognized as critical assessments of post-stroke outcomes. Important PROs such as fatigue, depression, and pain affect approximately half of stroke survivors and predict post-stroke disability, higher burden of care, and worse physical health but the underlying mechanisms are poorly understood. Surprisingly, the contributions of poor or inadequate sleep to PROs including post-stroke fatigue and traditional stroke outcomes have not been well-studied but have direct implications for screening and treatment. This application represents an ancillary study to the highly successful, ongoing Brain Attack Surveillance in Corpus Christi (BASIC) Project (R01 NS38916), recently renewed through March 2024. In this population-based stroke surveillance study within a Texan bi-ethnic county, all acute ischemic stroke patients are interviewed and followed prospectively for 90- day outcomes, including a comprehensive set of PROs. This unique epidemiologic sample, with equal representation of non-Hispanic whites and Mexican Americans, allows for the exploration of effects of disrupted sleep on fatigue and stroke outcomes in general and specifically in Mexican Americans, a subgroup with higher stroke risk and worse stroke outcomes. This will be accomplished through application of state-of- the-art comprehensive but feasible portable polysomnography and the addition of measures of post-stroke fatigue to the BASIC Project. Incorporating polysomnography into our large, population-based stroke study significantly enhances the feasibility to obtain detailed sleep metrics in the stroke population. This study will represent the largest longitudinal study to-date of full polysomnography among stroke patients. These highly translational aims will examine in a systematic manner the physiologic insight and clinical utility provided by polysomnography in relation to traditional and more patient-relevant stroke outcomes. Identification of sleep measures associated with poor stroke outcomes will identify potential treatment targets for stroke recovery and a potential target to reduce an important ethnic health disparity.