Sleep-related predictors of function and health among vulnerable older people

描述（由申请人提供）：本次k奖的总体目标是促进我成为一名独立的临床研究人员，研究有功能衰退风险的老年人的炎症标志物和白天睡眠。该研究领域与NIA的使命直接相关，即解决与年龄相关的疾病和问题，并提供与衰老相关的研究培训。我的短期目标是发展免疫学方面的新技能，以补充我之前在行为医学和健康心理学方面的培训，并进行细胞因子、睡眠和康复结果的研究。这次K-奖中提出的职业发展活动是为了通过精心策划的培训活动为我提供新的技能，包括正式的课程，持续的系列讲座，科学会议，以及资深科学家的指导，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与免疫系统之间相互作用的认识。我的主要长期目标是使用一个全面的生物学模型来理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状况的潜力。我们提出的研究重点是一个特殊的弱势老年人群体：那些在急性康复环境中从急性疾病或损伤中恢复过来的老年人，我们之前发现，在康复期间白天睡眠越多，功能恢复越差。这个项目是由我之前的研究工作和我对生物标志物的兴趣发展而来的。该项目的具体目的是：1)研究急性康复后日间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年功能预后的关系；3)研究急性康复后老年人1年内死亡或入住养老院与急性康复后日间嗜睡的关系。该研究将与我的主要导师（Cathy Alessi博士）正在进行的急性后康复环境研究项目共享资源。参与者（n=222）将完成一系列评估，包括客观和主观的睡眠和功能评估，并将提供一份血液样本，用于检测急性康复后的促炎细胞因子（IL-6和ICAM-1）。参与者将被随访1年，以评估功能和健康结果。了解白天睡眠与面临死亡、养老院安置或功能下降风险的老年人免疫系统之间的关系，有可能改善功能和健康。这可能会对公共卫生产生巨大影响，因为有医疗问题的老年人数量持续增长，将资源用于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.