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Investigation of Sleep

睡眠调查

基本信息

批准号：
10761912
负责人：
Michael Brandon Westover
金额：
$ 32.52万
依托单位：
BETH ISRAEL DEACONESS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-01-07 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10761912
关键词：
Investigation Sleep

项目摘要

PROJECT SUMMARY / ABSTRACT: Investigation of Sleep in the Intensive Care Unit (ICU-SLEEP) Sleep deprivation is among the most common complaints about the ICU experience. ICU sleep tends to be light and non-restorative (as opposed to deep / restorative sleep), severely fragmented, and distributed throughout the day and night rather than consolidated into nighttime hours. Sleep deprived patients suffer from sleep debt, a condition of impaired attention and memory, and cognitive slowing. Sleep disturbances in the ICU arise not only from light and noise pollution, but also from drugs that interfere with brain activity involved in restorative sleep. Sleep deprivation has also been suggested as a major modifiable risk factors for acute encephalopathy, also known as delirium. Delirium is an acute state of confusion that affects up to 80% of ICU patients, and is one of six leading causes of preventable morbidity and mortality in hospitalized elderly patients. Many patients who survive delirium experience long-term cognitive impairment and loss of independence. Current medications used in the ICU to treat sleep problems (e.g. benzodiazepines, antipsychotics) do not induce natural sleep and do not prevent delirium. In contrast, we have found that the α2-adrenoceptor agonist dexmedetomidine can induce biomimetic sleep, a brain state whose pattern of electroencephalogram (EEG) activity, cerebral blood flow, and functional connectivity approximates restorative sleep. Moreover, a recent large clinical trial in post-surgical patients suggests that low-dose dexmedetomidine given overnight substantially reduces the risk of delirium. It is unknown whether this benefit is linked to improved sleep, or whether patients with better sleep while in the ICU have better long-term cognitive outcomes. Our central hypothesis is that sleep deprivation substantially mediates both the short- and long-term cognitive impairments associated with delirium in critical illness. To test this hypothesis, our specific aims are designed to systematically determine 1) the impact of prophylactic dexmedetomidine on sleep quality, 2) the optimal way to give dexmedetomidine (all night vs at the beginning of the night only), 2) the impact of sleep deprivation on short-term cognitive function and delirium, and 3) the contribution of sleep deprivation to long-term neuropsychiatric outcome following critical illness. At the conclusion of these studies, we will have expanded our knowledge of sleep physiology in critical illness and relationship of sleep with delirium; evaluated a new preemptive therapeutic strategy to promote sleep and prevent delirium, and developed an understanding of how sleep impacts neuropsychological outcomes after critical illness. Our studies will thus will provide crucial guidance for individualized approaches to preserving long-term brain health in this vulnerable patient population.

项目总结/摘要：重症监护病房（ICU-SLEEP）的睡眠调查睡眠剥夺是ICU经历中最常见的抱怨之一。ICU睡眠往往是轻度和非恢复性睡眠（与深度/恢复性睡眠相反），严重碎片化，分布白天和晚上，而不是集中在夜间。睡眠不足的病人会患上睡眠债，一种注意力和记忆力受损的状况，以及认知能力下降。ICU中的睡眠障碍不仅来自光和噪音污染，还来自干扰大脑活动的药物，恢复性睡眠睡眠剥夺也被认为是急性脑梗死的主要可改变的危险因素。脑病，也称为谵妄。谵妄是一种急性意识模糊状态，影响高达80%的ICU 是住院老年患者可预防的发病率和死亡率的六大主要原因之一。许多从谵妄中幸存下来的患者会经历长期的认知障碍和独立性丧失。目前在ICU中用于治疗睡眠问题的药物（例如苯二氮卓类、抗精神病药）不诱导自然睡眠且不能防止谵妄。相反，我们发现α2-肾上腺素受体激动剂右美托咪定可诱导仿生睡眠，这是一种脑状态，其脑电图（EEG）模式活动、脑血流量和功能连接接近恢复性睡眠。此外，最近在手术后患者中进行的大型临床试验表明，大大降低了精神错乱的风险。目前尚不清楚这种益处是否与改善睡眠有关，在ICU中睡眠更好的患者是否具有更好的长期认知结果。我们的中央一种假设是睡眠剥夺在很大程度上介导了短期和长期的认知障碍与危重病患者的谵妄有关。为了验证这一假设，我们的具体目标是系统地确定1）预防性右美托咪定对睡眠质量的影响，2）给予右美托咪定（整夜vs仅在夜晚开始时），2）睡眠剥夺对短期认知功能和谵妄，和3）睡眠剥夺的贡献，长期危重病后的神经精神病学结局。在这些研究结束时，我们将扩大我们对危重病患者睡眠生理学的了解以及睡眠与谵妄的关系;评估了一种新的先发制人的治疗策略，以促进睡眠和防止谵妄，并制定了一个理解，睡眠如何影响危重病后的神经心理学结果。因此，我们的研究将提供至关重要的指导个体化的方法，以保持这种脆弱患者的长期大脑健康人口

项目成果

期刊论文数量（121）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Sample Size Analysis for Machine Learning Clinical Validation Studies.

DOI：
10.3390/biomedicines11030685
发表时间：
2023-02-23
期刊：
Biomedicines
影响因子：
4.7
作者：
通讯作者：

Automated Annotation of Epileptiform Burden and Its Association with Outcomes.

DOI：
10.1002/ana.26161
发表时间：
2021-08
期刊：
Annals of neurology
影响因子：
11.2
作者：
Zafar SF;Rosenthal ES;Jing J;Ge W;Tabaeizadeh M;Aboul Nour H;Shoukat M;Sun H;Javed F;Kassa S;Edhi M;Bordbar E;Gallagher J;Moura V Jr;Ghanta M;Shao YP;An S;Sun J;Cole AJ;Westover MB
通讯作者：
Westover MB

ICU delirium burden predicts functional neurologic outcomes.

DOI：
10.1371/journal.pone.0259840
发表时间：
2021
期刊：
PloS one
影响因子：
3.7
作者：
Paixao L;Sun H;Hogan J;Hartnack K;Westmeijer M;Neelagiri A;Zhou DW;McClain LM;Kimchi EY;Purdon PL;Akeju O;Westover MB
通讯作者：
Westover MB

Randomized trial of lacosamide versus fosphenytoin for nonconvulsive seizures.

DOI：
10.1002/ana.25249
发表时间：
2018-06
期刊：
Annals of neurology
影响因子：
11.2
作者：
Husain AM;Lee JW;Kolls BJ;Hirsch LJ;Halford JJ;Gupta PK;Minazad Y;Jones JM;LaRoche SM;Herman ST;Swisher CB;Sinha SR;Palade A;Dombrowski KE;Gallentine WB;Hahn CD;Gerard EE;Bhapkar M;Lokhnygina Y;Westover MB;Critical Care EEG Monitoring Research Consortium
通讯作者：
Critical Care EEG Monitoring Research Consortium

Detecting Seizures and Epileptiform Abnormalities in Acute Brain Injury.