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

项目摘要 中风是导致长期残疾的主要原因，它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康复和康复的支柱 改善中风患者的身体功能。不幸的是，从急性中风中康复的患者面临着 睡眠质量差，无法恢复体力，睡眠对恢复和参与高强度的身体康复至关重要。 在急性康复期间，中风患者面临两个与睡眠相关的挑战：(1)身体不协调，经常 夜间不必要的干扰(生命体征、药物等)由于医疗或护理；以及(2)高风险 未确诊的睡眠呼吸障碍。 鉴于睡眠在促进神经恢复、运动学习、神经保护和 神经可塑性，针对这两个区域的提高睡眠的干预措施可以改善康复和 中风患者的康复结局。在这项提案中，一个由多学科研究人员组成的小组 在康复医学、睡眠医学、护理、物理治疗、可穿戴技术和 实施科学将适应、实施和评估最先进的干预措施，以促进睡眠 接受急性康复治疗的中风患者。午睡-康复，改编自我们以前的单位基础 干预，捆绑了两种促进睡眠的干预措施，以应对中风患者独特的睡眠挑战 急性康复期间的面孔：(1)护理教育和赋权，以减少不必要的干扰；(2) 筛查、诊断和治疗急性卒中期间出现的睡眠障碍呼吸的系统方案 康复。这项工作将在雪莉·瑞安能力实验室(SRALab)进行，这是有史以来第一个 研究型医院，将临床医生和研究人员聚集在一起，在 康复。他们的仿生医学中心的研究人员率先开发和验证了 高分辨率可穿戴传感器平台，通过连续的生物识别和 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、语音和 吞咽和步态质量)。这些传感器已在经过验证的临床测试期间进行了测试 住院活动(例如，治疗、休息时间、睡眠)。 我们的目标是研究午睡康复在改善睡眠和康复结果方面的有效性。 中风和出院回家后的急性康复。因为SRALab和SRALab有两个下限 病人是以准随机分配的方式入院的，我们可以在一个病房实行午睡康复，而在另一个病房实行午睡康复 单元接受常规护理(常规夜间护理和临床医生判断，要求进行睡眠检查)。这很自然 实验实现了差异法，控制相关协变量，以比较短 午睡康复室和普通护理病房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.