Obstructive Sleep Apnea and Glycemic Variability in Type 2 Diabetes

2 型糖尿病的阻塞性睡眠呼吸暂停和血糖变异

基本信息

批准号：
8634858
负责人：
Rashmi Nisha Aurora
金额：
$ 13.24万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-09 至 2019-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8634858
关键词：
Address Adjuvant Affect Age Animals Apnea Area Arousal Atherosclerosis Attention Award Basic Science Blood Glucose Self-Monitoring Blood Vessels Cardiovascular Diseases Categories Cessation of life Clinic Clinical Clinical Investigator Clinical Research Clinical Trials Communities Complex Continuous Positive Airway Pressure Counseling Critical Care Cross-Sectional Studies Data Diabetes Mellitus Energy Intake Environment Equilibrium Family Fasting Fostering Frequencies Functional disorder Funding Future General Population Glucose Glycosylated Hemoglobin Glycosylated hemoglobin A Goals Hand Health Sciences Healthcare Hemoglobin concentration result Hour Human Hyperglycemia Hypoxemia Individual Insulin Intervention Studies Investigation Journals Knowledge Life Style Link Lung Measures Medical Medicine Mentored Patient-Oriented Research Career Development Award Mentorship Metabolic Metabolic Control Metric Monitor Non-Insulin-Dependent Diabetes Mellitus Obesity Obstructive Sleep Apnea Outcome Oxygen Oxyhemoglobin Patients Peer Review Physicians Public Health Schools Publications Race Randomized Controlled Clinical Trials Recording of previous events Research Risk Risk Factors Scientist Severities Sleep Sleep Disorders System Testing Therapeutic Thick Time Training Training Programs Uncontrolled Study Universities Wakefulness Work adverse outcome base blood glucose regulation cardiovascular risk factor career clinically relevant cohort diabetes management diabetic experience fasting glucose glucose metabolism glucose monitor glycemic control high risk improved indexing innovation intima media knowledge base macrovascular disease medical schools meetings patient oriented research pressure public health relevance sedentary

项目摘要

DESCRIPTION (provided by applicant): Obstructive sleep apnea (OSA) and type 2 diabetes mellitus are prevalent medical conditions each with significant adverse consequences. Over the last decade, a large body of empirical evidence has shown that OSA is prevalent in patients with diabetes and that the association between these two conditions is independent of adiposity. Animal and clinical studies have demonstrated that intermittent hypoxemia and sleep disruption in OSA may alter glucose homeostasis and impair glycemic control. Several questions remain, however, about the association between OSA and diabetes. Research characterizing the impact of OSA severity on post-prandial hyperglycemia and glycemic variability are lacking. It is well established that, while global measure of glycemic control, such as glycosylated hemoglobin levels (HbA1c), can predict vascular complications, post-prandial hyperglycemic with large glycemic excursions are independently predictive of vascular complications including carotid intima-media thickness, atherosclerosis, and macrovascular disease in individuals with diabetes Accordingly, the first aim of the current proposal is to characterize the cross-sectional association between OSA severity, glycemic control, post-prandial hyperglycemia, and glycemic variability in a cohort of patients with diabetes. Characterizing these associations is central in accomplishing the second aim of the proposed investigation - determining if treatment of OSA with continuous positive airway pressure (CPAP) therapy in patients with diabetes is associated with improvements in glycemic control, post-prandial hyperglycemia, and glycemic variability. To accomplish these aims, patients with diabetes will undergo sleep testing to identify and classify OSA severity. Actigraph monitoring (to quantify sleep duration), caloric intake, and several metrics of glucose homeostasis (continuous glucose monitoring, 7- point self-monitoring blood glucose profiles, and HbA1c) will be obtained. Indices of OSA severity will be related to metrics of glycemic load with careful consideration of confounders. Thus, two parallel and unique lines of scientific inquiry - a cross-sectional and an interventional study - will be utilized to gain a ore comprehensive understanding of the relevance of OSA as a modifier of glucose metabolism. Perhaps, the most innovative and practically relevant contribution of this research is the assessment of whether CPAP therapy could improve glycemic control and be considered an "adjuvant" in the therapeutic armamentarium for diabetes. If the hypotheses proposed in this application are correct, the resulting data will have a paradigm shifting effect on diabetes management. The K23 Mentored Patient-Oriented Research Career Development Award is the ideal platform to successfully carry out the proposed investigations outlined above and fulfill my long-term career goal and professional aspiration of becoming an independent clinical investigator in sleep disorders medicine. Through the K23 mechanism, I anticipate progressing towards my long-term objective by successfully completing each of the following short-term goals over the course of the award: 1) obtaining much needed formal training in clinical investigation by pursuing a Masters in Health Science degree through the Graduate Training Program in Clinical Investigation at the Bloomberg School of Public Health, 2) working closely with my expert and dedicated mentorship team to execute the proposed research, and 3) presenting the findings at scientific meetings and through publication in peer-reviewed journals. My unwavering commitment towards becoming an independent clinical investigator in sleep medicine is evidenced by my decision to redirect my career and move to Johns Hopkins University, where I could be immersed in a supportive and dedicated academic environment with an unparalleled mentorship team. The intellectual and clinical environments at the Johns Hopkins School of Medicine, Bloomberg School of Public Health, and Division of Pulmonary and Critical Care Medicine are ideal to carry out the proposed research and foster a career in clinical research.

描述（由申请人提供）：阻塞性睡眠呼吸暂停（OSA）和2型糖尿病是普遍的医疗状况，每种状况都有明显的不良后果。在过去的十年中，大量的经验证据表明，OSA在糖尿病患者中普遍存在，并且这两种疾病之间的关联与肥胖无关。动物和临床研究表明，OSA中间歇性低氧和睡眠破坏可能会改变葡萄糖稳态并损害血糖控制。但是，关于OSA和糖尿病之间的关联仍然存在一些问题。缺乏表征OSA严重程度对餐后高血糖和血糖变异性的影响的研究。众所周知，尽管全球对血糖控制的度量，例如糖基化血红蛋白水平（HBA1C），可以预测血管并发症，后质量高血糖和大量糖血糖的散发性具有独立的血管并发性，包括血管并发，包括颈动脉内膜症状，伴有症状的症状，伴有症状的疾病，并伴有肌肉症的疾病，并伴有触发性疾病，并伴有肌肉症的疾病，并伴有细胞度的疾病，并伴有毛刺性疾病。建议是表征OSA严重程度，血糖控制，后原质量血糖和血糖变异性之间的横截面关联。表征这些关联是完成拟议研究的第二个目标的核心 - 确定在糖尿病患者中对OSA进行持续阳性阳性阳性治疗的治疗是否与血糖控制，后源性高血糖症和血糖变异性的改善有关。为了实现这些目标，糖尿病患者将接受睡眠测试以识别和对OSA严重性进行分类。 Actigraph监测（量化睡眠持续时间），热量摄入量和几种葡萄糖稳态（连续葡萄糖监测，7点自我监测的血糖概谱和HBA1C）的几种指标。 OSA严重性指标将与血糖负荷的指标有关，并仔细考虑混杂因素。因此，将利用两种平行和独特的科学探究线 - 一项横断面和一项介入研究 - 可以全面了解OSA作为葡萄糖代谢修饰的相关性。也许，这项研究的最具创新性和实际上相关的贡献是评估CPAP治疗是否可以改善血糖控制，并被认为是糖尿病治疗武器库中的“辅助”。如果此应用程序中提出的假设正确，则结果数据将对糖尿病管理产生范式转移效果。 K23指导的以患者为导向的研究职业发展奖是成功地进行上述概述的拟议调查的理想平台，并实现了我的长期职业目标以及成为独立的睡眠障碍医学临床研究者的专业愿望。通过K23机制，我预计通过在奖励过程中成功完成以下每个短期目标，从而朝着我的长期目标迈进：1）通过通过临床研究的临床培训计划在临床研究中获得急需的正式培训会议和通过同行评审期刊的出版。我决定将自己的职业重定向并搬到约翰·霍普金斯大学（Johns Hopkins University）的决定证明，我坚定不移地成为一名独立的睡眠医学临床研究者，在那里我可以通过无与伦比的指导团队沉浸在支持性和专心的学术环境中。约翰·霍普金斯医学院，彭博公共卫生学院以及肺和重症监护医学部的智力和临床环境是进行拟议的研究并培养临床职业的理想选择研究。