Sleep Management And Recovery after Traumatic Brain Injury in Kids (SMART-Kids): Evidence for targeting sleep to improve outcomes

项目摘要 睡眠对于儿童时期的大脑成熟和发育以及受伤后的神经元愈合至关重要。 创伤性脑损伤（TBI）是一种常见的儿科危重疾病，每年影响超过50，000名儿童， 其中一半患有急性和慢性睡眠觉醒障碍（SWD），导致生活质量受损。这些 儿童在受伤后的许多年里也会遭受严重的认知障碍，特别是在以下领域： 执行功能，导致学习成绩下降和心理社会功能障碍。是否睡觉 TBI后的这些认知障碍的显著复合仍然是未知的。此外，有效 已证明可预防或改善这些易受伤害儿童的社会福利和执行功能障碍的疗法包括： 缺乏这项建议的核心假设是，社署是一个独立和可调整的风险因素， TBI幸存儿童的执行功能障碍。建议研究的目标是：1） 确定儿童TBI后SWD和执行功能之间的纵向联系， 采用问卷调查和客观测量的前瞻性队列研究，2）评估可行性， 一项在住院期间开始的早期褪黑激素和睡眠管理干预的有效性， 单中心随机对照试验。 博士Cydni威廉姆斯是俄勒冈州健康与科学大学的儿科重症监护医生，她在那里 在儿科重症监护室中对危重患儿进行急性护理，并在重症监护室中进行纵向护理 后续诊所她的工作已将社会福利署确定为影响一半以上重症监护的重要疾病 幸存者，特别是她所关注的大量TBI幸存者。她的长期目标是提高 通过严格的研究确定有效的干预措施， 儿童重症监护后的睡眠障碍，首先评估TBI幸存者的高风险队列。这 职业发展计划将为威廉姆斯博士提供指导睡眠的经验和指导培训 研究、临床试验方法和纵向数据分析。这一建议意义重大，因为它 解决了影响数千名儿童TBI幸存者的社会福利署常见和令人衰弱的发病率 每年，通过测试早期睡眠管理干预来推进临床护理和研究， 与美国国立卫生研究院睡眠障碍研究计划保持一致。这项研究和多- 学科指导培训将为威廉姆斯博士提供所需的数据和研究专业知识， 独立的研究基金，以评估儿童创伤性脑损伤和其他严重疾病幸存者的社会福利署。

Project Summary Sleep is critical for brain maturation and development in childhood, and for neuronal healing after injury. Traumatic brain injury (TBI) is a common pediatric critical illness affecting more than 50,000 children annually, half of whom suffer acute and chronic sleep wake disturbances (SWD) leading to impaired quality of life. These children also suffer substantial cognitive impairments for many years after injury, particularly in domains of executive function, leading to reduced academic performance and psychosocial dysfunction. Whether sleep disturbances significantly compound these cognitive deficits after TBI remains unknown. Additionally, effective therapies shown to prevent or improve SWD and executive dysfunction among these vulnerable children are lacking. The central hypothesis of this proposal is that SWD are an independent and modifiable risk factor for executive function impairment in children surviving TBI. The objectives of the proposed research are to: 1) Determine the longitudinal association between SWD and executive function after pediatric TBI in a prospective cohort study using both questionnaires and objective measures, 2) Evaluate feasibility and effectiveness of an early melatonin and sleep management intervention started during hospitalization in a single-center randomized controlled trial. Dr. Cydni Williams is a Pediatric Critical Care physician at Oregon Health & Science University where she cares for critically ill children acutely in the pediatric intensive care unit and longitudinally in a critical care follow-up clinic. Her work has identified SWD as an important morbidity affecting more than half of critical care survivors, particularly in the large number of TBI survivors she follows. Her long-term goal is to improve longitudinal outcomes and quality of life through rigorous studies identifying effective interventions to improve sleep disturbances after pediatric critical care, by first evaluating the high risk cohort of TBI survivors. This career development proposal will provide Dr. Williams with experiential and mentored training conducting sleep research, clinical trial methodology, and longitudinal data analyses. This proposal is significant because it addresses the common and debilitating morbidity of SWD that affect thousands of pediatric TBI survivors annually, advances clinical care and research through testing an early sleep management intervention, and aligns with the National Institutes of Health Sleep Disorders Research Plan. This research and multi- disciplinary mentored training will provide Dr. Williams with data and research expertise needed to pursue independent research funding to evaluate SWD in pediatric TBI and other critical illness survivors.