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名独立的临床研究人员的发展，研究有功能衰退风险的老年人的炎症标志物和日间睡眠。这一研究领域与NIA的使命直接相关，即解决与年龄有关的疾病和问题，并提供与老龄化有关的研究方面的培训。我的短期目标是开发新的免疫学技能，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。这项K奖中提出的职业发展活动是为了通过精心计划的培训活动为我提供新的技能，包括正式课程、持续的讲座系列、科学会议和资深科学家的指导，以扩大我对免疫学(特别是促炎细胞因子)、免疫功能随年龄的变化以及睡眠和免疫系统之间的相互作用的知识。我的主要长期目标是使用一个全面的生物学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结果的可能性。拟议的研究侧重于一组特定的弱势老年人：那些在急性康复后环境中从急性疾病或伤害中恢复的人，我们先前发现，在康复期间白天睡眠更多预示着较差的功能恢复。这个拟议的项目是从我之前的研究工作和我对生物标记的兴趣发展而来的。拟议项目的具体目标是：1)检查急性后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年功能结果之间的关系；3)检查接受急性后康复治疗的老年人中急性后康复期间白天嗜睡与1年内死亡或被安置在疗养院之间的关系。这项研究将与我的主要导师(凯西·阿莱西博士)共享资源，正在进行的急性康复环境下的研究项目。参与者(n=222)将完成一组评估，包括对睡眠和功能的客观和主观评估，并提供一份血液样本，在急性康复后的过程中检测促炎症细胞因子(IL-6和ICAM-1)。参与者将接受为期一年的跟踪，以评估功能和健康结果。了解有死亡风险、养老院安置或功能下降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。随着患有医疗问题的老年人的数量继续增加，这可能会对公共卫生产生巨大的影响，而针对资源来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.