Kervezee Laura, Dashti Hassan S, Pilz Luísa K, Skarke Carsten, Ruben Marc D
Group of Circadian Medicine, Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
PLOS Digit Health. 2024 May 23;3(5):e0000511. doi: 10.1371/journal.pdig.0000511. eCollection 2024 May.
A wealth of data is available from electronic health records (EHR) that are collected as part of routine clinical care in hospitals worldwide. These rich, longitudinal data offer an attractive object of study for the field of circadian medicine, which aims to translate knowledge of circadian rhythms to improve patient health. This narrative review aims to discuss opportunities for EHR in studies of circadian medicine, highlight the methodological challenges, and provide recommendations for using these data to advance the field. In the existing literature, we find that data collected in real-world clinical settings have the potential to shed light on key questions in circadian medicine, including how 24-hour rhythms in clinical features are associated with-or even predictive of-health outcomes, whether the effect of medication or other clinical activities depend on time of day, and how circadian rhythms in physiology may influence clinical reference ranges or sampling protocols. However, optimal use of EHR to advance circadian medicine requires careful consideration of the limitations and sources of bias that are inherent to these data sources. In particular, time of day influences almost every interaction between a patient and the healthcare system, creating operational 24-hour patterns in the data that have little or nothing to do with biology. Addressing these challenges could help to expand the evidence base for the use of EHR in the field of circadian medicine.
全球各地医院在日常临床护理过程中收集了大量电子健康记录（EHR）数据。这些丰富的纵向数据为昼夜节律医学领域提供了极具吸引力的研究对象，该领域旨在转化昼夜节律知识以改善患者健康。本叙述性综述旨在探讨EHR在昼夜节律医学研究中的机遇，突出方法学挑战，并为利用这些数据推动该领域发展提供建议。在现有文献中，我们发现现实世界临床环境中收集的数据有可能阐明昼夜节律医学中的关键问题，包括临床特征的24小时节律如何与健康结果相关联甚至预测健康结果、药物或其他临床活动的效果是否取决于一天中的时间，以及生理上的昼夜节律如何影响临床参考范围或采样方案。然而，要最佳利用EHR推动昼夜节律医学发展，需要仔细考虑这些数据源固有的局限性和偏差来源。特别是，一天中的时间几乎影响患者与医疗系统之间的每一次互动，在数据中形成与生物学几乎无关或完全无关的24小时操作模式。应对这些挑战有助于扩大EHR在昼夜节律医学领域应用的证据基础。
