Sleep and Cognition after Left Ventricular Assist Device Implantation

项目总结 Ruth L.Kirschstein国家研究服务奖(NRSA)个人博士前研究的目的 护理研究奖学金(F31)申请是为二年级的郑先生提供研究培训 华盛顿大学护理学院的博士生。此次培训的长期目标是 此申请者将在研究密集的学术环境中发展成为一名独立的有影响力的研究员 与创新和富有成效的跨学科项目。这项研究将致力于整合 将生理学措施纳入生物行为干预以减轻和改善个体的症状负担 拥有先进的心力衰竭(AHF)和机械循环支持(MCS)设备。急性心力衰竭患者 尽管接受了最大限度的药物治疗，但仍经历了严重的顽固症状负担。心脏移植是 AHF的最佳治疗方案。然而，器官短缺和不适合移植使MCS设备， 例如左心辅助装置(LVADs)，这是高龄患者的唯一治疗选择 以及需要长期支持的共病情况，称为目的地疗法(DT)。数量 随着机械装置耐久性的提高，接受DT-LVAD的患者正在迅速增长 DT-LVAD的支持，并扩大了适应症，将早期心力衰竭患者包括在内。而当 关于心力衰竭患者的睡眠和睡眠障碍的研究很广泛，调查的睡眠 DT-LVAD接受者的一个重要临床结果没有跟上迅速扩大的治疗方法的步伐 AHF治疗的MCS适应症和不断发展的技术进步。更好地了解LVAD效应 对身体和心理症状的关注将是有效护理和支持LVAD患者的关键 植入后。这项前瞻性并行混合方法研究的目的是描述 DT-LVAD术后3个月AHF患者的客观和主观睡眠质量 睡眠质量的变化与认知功能、心理变化之间的关系 症状和与健康相关的生活质量。此外，这一奖项将为博士后实习生通过 先进的课业和直接的研究经验，使用混合的方法，重点分析 植入LVAD后观察到的症状变化，并发现多个睡眠之间高度相关的联系 以及与AHF相关的症状。调查结果将为以下方面提供基础知识 建立AHF症状及症状管理学研究新方案。

PROJECT SUMMARY The purpose of this Ruth L. Kirschstein National Research Service Award (NRSA) Individual Pre-Doctoral Fellowship in Nursing Research (F31) application is to provide research training for Mr. Zheng, a second-year doctoral student at the University of Washington School of Nursing. The long-term goal of this training is for this applicant to develop into an independent influential researcher in a research-intensive academic setting with an innovative and productive interdisciplinary program. This research will be dedicated to integrating physiologic measures into bio-behavioral interventions to reduce and ameliorate symptom burden in individuals with advanced heart failure (AHF) and mechanical circulatory support (MCS) devices. Individuals with AHF experience severe refractory symptom burden despite maximum medical therapy. Cardiac transplant is the optimal treatment option for AHF. However, organ shortage and ineligibility for transplant make MCS devices, such as Left Ventricular Assist Devices (LVADs), the only treatment option for individuals with advanced age and comorbid conditions requiring permanent support, known as destination therapy (DT). The number of patients attaining longer-term survival with DT-LVAD is rapidly growing with increased durability of mechanical support, and expanded indications for DT-LVAD to include patients in earlier stages of heart failure. While studies on sleep and sleep disorders among individuals with heart failure are extensive, investigating sleep as an important clinical outcome for DT-LVAD recipients has not kept pace with the rapidly expanding therapeutic indications and evolving technology advancements in MCS for AHF care. Better understanding of LVAD effects on physical and psychological symptoms will be essential to effectively care for, and support LVAD patients post-implant. The purpose of this prospective concurrent mixed-methods study is to describe changes in objective and subjective sleep quality at 3 months in persons with AHF following DT-LVAD, and to determine associations between change in sleep quality as they relate to changes in cognitive function, psychological symptoms and health-related quality of life. Moreover, this award will prepare a pre-doctoral trainee through advanced coursework and direct research experience, the use of mixed methods, focused analysis of symptom changes observed post-LVAD implant, and discovery of highly relevant links among multiple sleep and AHF-related symptoms. Findings generated from this investigation will provide foundational knowledge for building a new program of research in symptom and symptom management science in AHF.