Sleep Quality and Cognitive Function in Hospitalized Older Adult Survivors of Critical Illness

项目摘要/摘要 近25%的重症监护病房(ICU)幸存者经历了ICU后的认知障碍 与轻度阿尔茨海默病相当；约33%的人患有相当于 中度创伤性脑损伤。危重的老年人(65岁及以上)的发病率最高。 机械通气是ICU后认知功能障碍的高危人群。机械通风ICU 患者的睡眠比那些没有呼吸机的人睡眠更差。拟议中的研究集中在老年人身上 需要机械通风才能生存的成年ICU幸存者。科学前提是：1)睡眠 缺乏可能与ICU后综合症和认知障碍有关，2)睡眠可能是一种 可改变的危险因素以预防ICU后认知功能障碍。了解睡眠不足对于 设计个性化的症状管理干预措施，以防止ICU后认知能力下降。这是第一次 睡眠不足对老年患者ICU后认知功能损害纵向影响的研究 成年ICU幸存者。具体目标1是确定白天和夜间的睡眠质量(睡眠结构 和睡眠环境)的老年成年ICU幸存者谁需要在ICU期间机械通风。沉睡 (即多导睡眠图和活动记录仪)将在转出ICU时进行测量，并在第1和第3次测量 出院后几个月。多导睡眠图将描述睡眠结构(睡眠持续时间、效率、 分裂、潜伏期；N1、N2、N3和REM期；以及皮质和交感觉醒)。动作记录法 将描述睡眠环境(环境光/暗水平和运动/静止)。具体目标2是确定 睡眠不足与ICU后认知功能障碍纵向关系的效应大小。 认知功能(即执行功能和工作记忆)将在转出ICU时进行评估， 在出院后1个月和3个月再次使用从NIH工具箱中选择的测量方法 认知电池。其他相关数据(生物变量，包括年龄、性别、种族/民族和临床 例如阻塞性睡眠呼吸暂停病史)，以探讨睡眠不足和睡眠后的危险因素。 ICU认知障碍。数据将提供发展护理干预措施的方向(例如，促进 巩固睡眠，调整睡眠环境，重建昼夜节律，减少白天 昏昏欲睡)，以最佳目标和预防ICU后认知障碍。拟议的研究将在#年进行。 迈阿密是美国最大的“少数族裔占多数”的大都市区之一，65%的人口是 西班牙裔/拉丁裔。拟议的项目将支持申请者的职业目标，以发展她的专业 作为一名护士科学家，具有个性化、严谨的症状科学研究和培训计划 纵向数据分析集中在老年病学、睡眠、认知神经心理学和危重护理上。这个 拟议的培训计划整合了跨学科指导小组的科学和分析专门知识。

Project Summary/Abstract Almost 25% of intensive care unit (ICU) survivors experience post-ICU cognitive impairment comparable to that of mild Alzheimer’s disease; about 33% suffer from cognitive impairment equivalent to moderate traumatic brain injury. Critically ill older adults (ages 65 and older) have the highest incidence of mechanical ventilation and are at most risk for post-ICU cognitive impairment. Mechanically ventilated ICU patients experience worse sleep than those who are not ventilated. The proposed research focuses on older adult ICU survivors who required mechanical ventilation for survival. The scientific premises are: 1) sleep deficiency may be associated with post-ICU syndrome and cognitive impairment, and 2) sleep may be a modifiable risk factor to prevent post-ICU cognitive impairment. Understanding sleep deficiency is essential to design personalized symptom management interventions to prevent post-ICU cognitive decline. This is the first study to evaluate the longitudinal effect of sleep deficiency on post-ICU cognitive impairment among older adult ICU survivors. Specific Aim 1 is to determine the daytime and nighttime sleep quality (sleep architecture and sleep environment) of older adult ICU survivors who required mechanical ventilation while in ICU. Sleep (i.e., polysomnography and actigraphy) will be measured at time of transfer out of ICU, and again at 1 and 3 months post-hospital discharge. Polysomnography will describe sleep architecture (sleep duration, efficiency, fragmentation, and latency; N1, N2, N3, and REM stages; and cortical and sympathetic arousals). Actigraphy will describe sleep environment (ambient light/dark levels and motion/inactivity). Specific Aim 2 is to determine the effect size of the longitudinal relationship between sleep deficiency and post-ICU cognitive impairment. Cognitive function (i.e., executive function and working memory) will be assessed at time of transfer out of ICU, and again at 1 and 3 months post-hospital discharge, using selected measures from the NIH Toolbox Cognition Battery. Additional related data (biological variables including age, sex, race/ethnicity, and clinical history such as obstructive sleep apnea) will be collected to explore risk factors for sleep deficiency and post- ICU cognitive impairment. Data will provide direction on development of nursing interventions (e.g., promoting sleep consolidation, restructuring sleep environment, reestablishing circadian rhythm, decreasing daytime sleepiness) to best target and prevent post-ICU cognitive impairment. The proposed research will take place in one of the largest “minority-majority” metropolitan areas in the United States—65% of Miami’s population is Hispanic/Latino. The proposed project will support the applicant in her career goal to develop her professional identity as a nurse scientist, with an individualized, rigorous training program of symptom science research and longitudinal data analysis centered on geriatrics, sleep, cognitive neuropsychology, and critical care. The proposed training plan integrates the scientific and analytic expertise of an interdisciplinary mentorship team.