Sleep-related predictors of function and health among vulnerable older people

描述（由申请人提供）：这个K奖的总体目标是促进我作为一个独立的临床研究人员的发展，研究炎症标志物和老年人日间睡眠功能下降的风险。该研究领域与NIA的使命直接相关，该使命旨在解决与年龄相关的疾病和问题，并提供与衰老相关的研究培训。我的短期目标是发展免疫学方面的新技能，以补充我之前在行为医学和健康心理学方面的培训，并对细胞因子，睡眠和康复结果进行研究。在这个K奖中提出的职业发展活动被选中，通过精心策划的培训活动为我提供新的技能，包括正式的课程，正在进行的系列讲座，科学会议，以及资深科学家的指导，以扩大我对免疫学（特别是促炎细胞因子）的知识，随着年龄的增长，免疫功能的变化，以及睡眠和免疫系统之间的相互作用。我的主要长期目标是使用一个全面的生物模型来了解免疫系统和睡眠模式之间的相互作用，并研究改善睡眠模式以改善老年人健康状况的潜力。拟议的研究重点关注特定的弱势老年人群体：那些在急性后康复环境中从急性疾病或伤害中恢复的人，我们之前发现康复期间白天睡眠较多预示着功能恢复较差。这个项目的提出是基于我之前的研究工作和我对生物标记的兴趣。该项目的具体目标是：1）检查急性康复期间白天嗜睡与促炎细胞因子水平之间的关系; 2）检查康复期间促炎细胞因子水平与1年功能结局之间的关系;以及3）检查急性期后康复期间白天嗜睡与1年内死亡或疗养院安置之间的关系，在接受急性期后康复治疗的老年人中。这项研究将与我的主要导师（Cathy Alessi博士）在急性后康复环境中正在进行的研究项目共享资源。参与者（n=222）将完成一系列评估，包括睡眠和功能的客观和主观评估，并将提供一份血样，在急性康复后进行促炎细胞因子（IL-6和ICAM-1）测定。参与者将被随访1年，以评估功能和健康结果。了解有死亡风险、养老院安置或功能衰退的老年人白天睡眠与免疫系统之间的关系，有可能改善功能和健康。这可能会对公共卫生产生巨大影响，因为有医疗问题的老年人数量不断增加，将资源用于改善结果变得越来越重要。

DESCRIPTION (provided by applicant): The overall objective of this K-Award is to facilitate my development as an independent clinical researcher studying inflammatory markers and daytime sleeping among older people at risk for functional decline. This research area is directly relevant to the NIA's mission to address age-related diseases and problems and to provide training in aging related research. My short-term goals are to develop new skills in immunology to compliment my prior training in behavioral medicine and health psychology and to conduct research on cytokines, sleep and rehabilitation outcomes. The career development activities proposed within this K- Award were selected to provide me with new skills through carefully planned training activities, including formal coursework, ongoing lecture series, scientific meetings, and mentorship from senior scientists to expand my knowledge about immunology (particularly proinflammatory cytokines), changes in immune functioning with age, and the interactions between sleep and the immune system. My primary long-term goal is to use a comprehensive biological model to understand interactions between the immune system and sleep patterns and examine the potential for improved sleep patterns to improve health outcomes for older people. The proposed research focuses on a specific group of vulnerable older people: those recovering from acute illness or injury in the post-acute rehabilitation setting, where we have previously found that more daytime sleeping during rehabilitation predicts poorer functional recovery. The proposed project developed from this prior research work and my interest in biological markers. The specific aims of the proposed project are to: 1) examine the relationship between daytime sleepiness during post-acute rehabilitation and levels of proinflammatory cytokines; 2) examine the relationship between levels of proinflammatory cytokines during rehabilitation and 1-year functional outcomes; and 3) examine the relationship between daytime sleepiness during post-acute rehabilitation and death or nursing home placement within 1 year, among older people receiving post-acute rehabilitation. The study will share resources with my primary mentor's (Dr. Cathy Alessi) ongoing research projects in the post-acute rehabilitation setting. Participants (n=222) will complete an assessment battery including objective and subjective assessments of sleep and function, and will provide one blood sample, which will be assayed for proinflammatory cytokines (IL-6 and ICAM-1) during post-acute rehabilitation. Participants will be followed for 1 year to assess functional and health outcomes. Understanding the relationship between daytime sleeping and the immune system among older people at risk for death, nursing home placement or functional decline has the potential to improve functioning and health. This may have trememdous public health impact as the number of older people with medical problems continues to grow, and targeting resources to improve outcomes becomes increasingly critical.