SIESTA (Sleep of Inpatients: Empower Staff to Act) for Acute Stroke Rehabilitation - Resubmission 01

项目摘要 中风是长期残疾的主要原因，降低了日常活动能力和沟通能力， 超过一半的幸存者。通过早期干预进行急性康复是恢复的主要手段， 改善中风患者的身体功能。不幸的是，从急性中风中恢复的患者有 睡眠不佳，非恢复性睡眠，而睡眠对于恢复和参与激烈的身体康复至关重要。 在急性康复期间，脑卒中患者面临两个与睡眠相关的挑战：（1）不协调， 不必要的夜间中断（生命体征、药物等）由于医疗或护理;（2）高风险 未确诊的睡眠呼吸障碍 考虑到睡眠在促进神经恢复、运动学习、神经保护和 神经可塑性，针对这两个区域的增强睡眠的干预措施可以改善恢复， 中风患者的康复结果。在这项提案中，一个多学科的研究小组， 在康复医学、睡眠医学、护理、物理治疗、可穿戴技术方面的专业知识，以及 实施科学将适应，实施和评估最先进干预措施，以促进睡眠， 中风患者接受急性康复治疗。SIESTA康复，改编自我们以前的单位为基础的 干预，捆绑两个睡眠促进干预措施，以解决独特的睡眠挑战中风患者 面对急性康复期间：（1）护理教育和授权，以减少不必要的干扰;（2） 一个系统的协议，以筛选，诊断和治疗睡眠呼吸障碍，如果在急性中风期间存在 康复活动.这项工作将在雪莉瑞安能力实验室（SRALab），有史以来第一个翻译 研究型医院，将临床医生和研究人员聚集在一起，在以下方面取得突破性发现： 康复活动.他们仿生医学中心的研究人员率先开发和验证了 一个高分辨率的可穿戴传感器平台，通过连续的生物特征监测中风恢复， 用于临床症状的基于运动的传感器数据（例如，运动、睡眠、心率变异性、言语和 吞咽和步态质量）。这些传感器已在经确认的临床试验期间进行了测试， 住院活动（例如，治疗、停机时间、睡眠）。 我们的目的是研究SIESTA康复治疗在改善睡眠和康复结果的有效性， 中风急性康复和出院后回家。因为SRALab有两个中风楼层， 病人是准随机分配入院，我们可以在一个单位实施SIESTA康复，而另一个 单元接受睡眠护理（常规夜间护理和临床医生判断以进行睡眠研究）。这种自然 实验使差异中的差异的方法，控制相关的协变量，比较短 以及SIESTA康复中心和家庭护理中心患者之间的长期睡眠和康复结果。

Project Summary Stroke is a leading cause of long-term disability, reducing everyday mobility and communication skills in more than half of survivors. Acute rehabilitation through early interventions is a mainstay for recovery and improving physical function in stroke patients. Unfortunately, patients recovering from acute stroke are at risk for poor, non-restorative sleep, when sleep is critical for recovery and participation in intense physical rehabilitation. During acute rehabilitation, stroke patients face two sleep-related challenges: (1) uncoordinated and often unnecessary nocturnal interruptions (vitals, medications, etc.) due to medical or nursing care; and (2) a high risk of undiagnosed sleep disordered breathing. Given the critical role of sleep in enhancing neural recovery, motor learning, neuroprotection, and neuroplasticity, interventions to enhance sleep that target these two areas could improve recovery and rehabilitation outcomes for stroke patients. In this proposal, a multidisciplinary group of researchers with expertise in rehabilitation medicine, sleep medicine, nursing, physical therapy, wearable technologies, and implementation science will adapt, implement and evaluate a state-of-the-art intervention to promote sleep for stroke patients undergoing acute rehabilitation. SIESTA-Rehab, adapted from our previous unit-based intervention, bundles two sleep-promoting interventions to address the unique sleep challenges stroke patients face during acute rehabilitation: (1) nursing education and empowerment to reduce unnecessary disruptions; (2) a systematic protocol to screen, diagnose, and treat sleep-disordered breathing if present during acute stroke rehabilitation. This work will take place at the Shirley Ryan Ability Lab (SRALab), the first-ever translational research hospital that brings clinicians and researchers together to make breakthrough discoveries in rehabilitation. Researchers at their Center for Bionic Medicine have pioneered the development and validation of a high-resolution wearable sensor platform to monitor stroke recovery via continuous biometric and movement-based sensor data for clinical symptoms (e.g., movement, sleep, heart rate variability, speech & swallowing, and gait quality). These sensors have been tested during performance of validated clinical tests and inpatient activities (e.g., therapy, down-time, sleeping). We aim to study the effectiveness of SIESTA-Rehab on improving sleep and rehabilitation outcomes during acute rehabilitation for stroke and after discharge home. Because there are two stroke floors at SRALab and patients are admitted in a quasi-random allocation, we can implement SIESTA-Rehab in one unit while the other unit receives Usual Care (routine night nursing care and clinician judgment to order sleep study). This natural experiment enables a difference-in-differences approach, controlling for relevant covariates, to compare short and long-term sleep and rehabilitation outcomes between patients in the SIESTA-Rehab and Usual Care units.