Improving the Sleep and Circadian Rhythms of Mechanically Ventilated Patients

简介（由申请人提供）：Brian K. Gehlbach，医学博士，芝加哥大学肺科和重症监护科医学助理教授，寻求研究职业发展的支持，以建立一个专注于危重患者睡眠障碍和昼夜节律的临床研究者的职业生涯。Gehlbach博士将在Eve Van Cauter博士的指导下发展他的研究技能，Eve Van Cauter博士是正常和病理状态下睡眠和昼夜节律的知名权威。他将与杰西·霍尔博士共同指导，杰西·霍尔博士是一位在危重症方面颇有成就的研究者，也是机械通气患者镇静方面的权威。神经生理学专家、睡眠研究项目主任Jean-Paul Spire博士将在多导睡眠图的解读方面提供额外的指导。此外，Gehlbach博士将参加由美国国立卫生研究院资助的临床研究培训计划赞助的证书课程。拟议的研究项目旨在表征危重患者的睡眠和昼夜节律，并探索非药物干预的功效。该提案的具体目的是表征危重患者接受机械通气的睡眠数量和质量，检查采用降噪和强制强光暗周期的方案对睡眠质量和昼夜节律的影响，并检查睡眠中断与昼夜节律丧失和谵妄发展之间的关系。睡眠将通过使用连续多导睡眠图进行分析，昼夜节律将通过频繁测量核心体温和尿激素水平来表征。在美国，每年有超过100万患者出现呼吸衰竭；然而，机械通气患者的睡眠却很少受到关注。该项目的目标是通过可以在床边使用的实用策略来改善危重病人的睡眠和昼夜节律。增加对睡眠质量的关注可以通过减少谵妄的发展和帮助患者从呼吸衰竭中恢复来改善临床结果。

DESCRIPTION (provided by applicant): Brian K. Gehlbach, MD, Assistant Professor of Medicine in the Section of Pulmonary and Critical Care at the University of Chicago, seeks support for research career development to establish a career as a clinical investigator with a focus on disturbances of sleep and circadian rhythmicity in critically ill patients. Dr. Gehlbach will develop his research skills under the mentorship of Dr. Eve Van Cauter, a well-known authority on sleep and circadian rhythms in normal and pathologic states. He will be co-mentored by Dr. Jesse Hall, an accomplished investigator in the critically ill and an authority on the sedation of mechanically ventilated patients. Dr. Jean-Paul Spire, an expert neurophysiologist and Director of the Sleep Fellowship Program, will provide additional mentoring where interpretation of the polysomnograms is concerned. In addition, Dr. Gehlbach will enroll in the certificate program sponsored by the university's NIH-funded Clinical Research Training Program. The proposed research project is designed to characterize sleep and circadian rhythmicity in critically patients and to explore the efficacy of a non-pharmacological intervention. The specific aims of the proposal are to characterize the quantity and quality of sleep in critically ill patients undergoing mechanical ventilation, to examine the effect of a protocol employing noise reduction and enforcement of a robust light-dark cycle on sleep quality and circadian rhythmicity, and to examine the relationship between sleep disruption and loss of circadian rhythmicity and the development of delirium. Sleep will be analyzed through the use of continuous polysomnography and circadian rhythmicity will be characterized through the measurement of core body temperature and urinary hormonal levels at frequent intervals. Over 1 million patients develop respiratory failure annually in the United States; yet, the sleep of patients undergoing mechanical ventilation has received little attention. The goal of this project is to improve the sleep and circadian rhythms of critically ill patients through practical strategies that can be employed at the bedside. Increased attention to sleep quality may improve clinical outcomes by reducing the development of delirium and helping patients recover from respiratory failure. (End of Abstract)