Improving the Sleep and Circadian Rhythms of Mechanically Ventilated Patients

描述(由申请人提供)：Brian K.Gehlbach，医学博士，芝加哥大学肺部和重症监护科医学助理教授，寻求对研究职业发展的支持，以建立一名临床调查员的职业生涯，重点关注危重患者的睡眠障碍和昼夜节律。格尔巴赫博士将在伊夫·范·考特博士的指导下发展他的研究技能。伊夫·范·考特是研究正常和病理状态下的睡眠和昼夜节律的知名权威。他将由杰西·霍尔博士共同指导，杰西·霍尔博士是危重病领域的一名有成就的研究人员，也是机械通气患者镇静方面的权威。让-保罗·斯皮尔博士是一位神经生理学家，也是睡眠联谊会计划的主任，他将在多导睡眠图的解释方面提供额外的指导。此外，格尔巴赫博士还将参加由国立卫生研究院资助的临床研究培训项目赞助的证书项目。这项拟议的研究项目旨在描述危重患者的睡眠和昼夜节律，并探索非药物干预的效果。该提案的具体目的是描述接受机械通气的危重患者的睡眠数量和质量，检查采用降噪和实施强健的明暗循环对睡眠质量和昼夜节律性的影响，以及检查睡眠中断和昼夜节律性丧失与精神错乱的发展之间的关系。睡眠将通过连续多导睡眠图进行分析，昼夜节律性将通过频繁间隔测量核心体温和尿激素水平来表征。在美国，每年有100多万患者出现呼吸衰竭；然而，接受机械通气的患者的睡眠很少受到关注。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患者的睡眠和昼夜节律。增加对睡眠质量的关注可能会通过减少神志不清的发展和帮助患者从呼吸衰竭中恢复来改善临床结果。 (摘要结束)

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)