Sleep Apnea, PAP Therapy, and Kidney Function Trajectory

睡眠呼吸暂停、PAP 治疗和肾功能轨迹

• 批准号: 8765891
• 负责人: Muna T Canales
• 金额: $ 23.43万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8765891
• 关键词: Address; Adult; Affect; American; Apnea; Area; California; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Chronic Kidney Failure; Clinical; Cohort Studies; Communities; Comorbidity; Computerized Medical Record; Creatinine; Data Collection; Data Set; Databases; Detection; Devices; Diabetes Mellitus; Diagnosis; Dialysis procedure; Disease; Disease Progression; Effectiveness; Electronic Health Record; End stage renal failure; Endocrine; Endocrine system; Evaluation; Foundations; Funding; Future; Glomerular Filtration Rate; Gold; Health; Healthcare; Hypertension; Individual; Intervention; Intervention Studies; Kidney; Kidney Diseases; Kidney Transplantation; Lead; Measurement; Measures; Modeling; Morbidity - disease rate; Neuraxis; Outcome; Patients; Population; Population Heterogeneity; Population Research; Prevention; Prospective Studies; Renal function; Research; Risk; Risk Factors; Serum; Severities; Site; Sleep; Sleep Apnea Syndromes; Testing; Time; United States National Institutes of Health; Wisconsin; base; clinical practice; cohort; comparison group; cost; effectiveness trial; improved; meetings; middle age; modifiable risk; mortality; novel; pressure; prevent; prospective; public health relevance; screening; standard measure; therapy outcome; trend

DESCRIPTION (provided by applicant): The purpose of this study is to determine if sleep apnea is a novel, modifiable risk factor for chronic kidney disease (CKD). We propose a study of existing data sets to help determine if kidney function loss is accelerated in patients who are diagnosed with sleep apnea, and if positive airway pressure (PAP) therapy for sleep apnea reduces the rate of kidney function loss. We will accomplish these aims through longitudinal analyses using two rich and complementary data sets: the Wisconsin Sleep Cohort and Kaiser Permanente Southern California (KPSC) Population Research Databases. Sleep apnea is common disorder affecting 1 in 5 Americans and can be effectively treated using PAP therapy. Sleep apnea shares a similar risk profile to CKD, including hypertension and diabetes, the two most common causes of end-stage kidney disease (ESKD). Sleep apnea is known to be deleterious to the cardiovascular, central nervous and endocrine systems. The relationship of sleep apnea to CKD is not yet clear. We hypothesize that a faster rate of kidney function loss will be observed in individuals who are later diagnosed with apnea and in individuals with more severe sleep apnea. We hypothesize that PAP therapy will slow kidney function loss and that effective PAP therapy will slow kidney function loss to a greater degree than ineffective therapy. The Wisconsin Sleep Cohort Study (WSCS) is 20-year ongoing NIH-funded prospective study of 1,522 middle-aged healthy adults with periodic assessments of sleep apnea severity using gold-standard measures, measures of PAP therapy adequacy, and serial serum creatinine tests from which kidney function may be estimated. The KPSC Population Research Databases contain validated case-identification of over 100,000 sleep apnea patients, including diagnosis and PAP device dispensation dates, and complete electronic medical records that include clinically obtained serum creatinine tests. In both cohorts, kidney function will be assessed based on the estimated glomerular filtration rate (eGFR). We will model eGFR trajectory using linear slopes and non-linear mixed models to compare eGFR trend before and after PAP therapy. In each cohort, a non- apnea comparison group will be constructed and major comorbidities will be controlled. We intend this study to directly inform the conduct of a future effectiveness trial in which screening and therapy for sleep apnea is compared across intervention and non-intervention sites utilizing active and passive data collection in a large population, such as KPSC. The results of this study have the potential to push forward a promising area of research that eventually may alter the evaluation and treatment of patients at high renal risk or with established CKD to help prevent related morbidity and mortality.

描述（由申请人提供）：本研究的目的是确定睡眠呼吸暂停是否是慢性肾病（CKD）的一种新的、可改变的危险因素。我们建议对现有数据集进行一项研究，以帮助确定被诊断为睡眠呼吸暂停的患者的肾功能丧失是否会加速，以及睡眠呼吸暂停的气道正压通气 (PAP) 治疗是否会降低肾功能丧失的速度。我们将通过使用两个丰富且互补的数据集进行纵向分析来实现这些目标：威斯康星州睡眠队列和南加州凯撒医疗机构 (KPSC) 人口研究数据库。 睡眠呼吸暂停是影响五分之一美国人的常见疾病，可以通过 PAP 疗法有效治疗。睡眠呼吸暂停与 CKD 具有相似的风险特征，包括高血压和糖尿病，这是终末期肾病 (ESKD) 的两个最常见原因。众所周知，睡眠呼吸暂停对心血管、中枢神经和内分泌系统有害。睡眠呼吸暂停与 CKD 的关系尚不清楚。我们假设，在后来被诊断为呼吸暂停的个体以及睡眠呼吸暂停更严重的个体中，肾功能丧失的速度会更快。我们假设 PAP 治疗将减缓肾功能丧失，并且有效的 PAP 治疗将比无效治疗更大程度地减缓肾功能丧失。 威斯康星州睡眠队列研究 (WSCS) 是一项为期 20 年的前瞻性研究，由 NIH 资助，对 1,522 名中年健康成年人进行了定期评估，使用金标准措施、PAP 治疗充分性措施和系列血清肌酐测试来评估睡眠呼吸暂停的严重程度。可以估计肾功能。 KPSC 人口研究数据库包含超过 100,000 名睡眠呼吸暂停患者的经过验证的病例识别，包括诊断和 PAP 设备配药日期，以及完整的电子医疗记录，包括临床获得的血清肌酐测试。在这两个队列中，将根据估计的肾小球滤过率（eGFR）评估肾功能。我们将使用线性斜率和非线性混合模型对 eGFR 轨迹进行建模，以比较 PAP 治疗前后的 eGFR 趋势。在每个队列中，将构建一个非呼吸暂停对照组并控制主要合并症。 我们希望这项研究能够直接为未来进行有效性试验提供信息 利用大量人群的主动和被动数据收集（例如 KPSC），对干预和非干预地点的睡眠呼吸暂停筛查和治疗进行比较。这项研究的结果有可能推动一个有前景的研究领域的发展，最终可能会改变对肾病高风险或已确诊 CKD 患者的评估和治疗，以帮助预防相关的发病率和死亡率。