Impact of Positive Airway Pressure Therapy on Clinical Outcomes in Older Veterans with Chronic Obstructive Pulmonary Disease and Comorbid Obstructive Sleep Apnea (Overlap Syndrome)

气道正压通气治疗对患有慢性阻塞性肺疾病和共病阻塞性睡眠呼吸暂停（重叠综合征）的老年退伍军人临床结果的影响

• 批准号: 10356081
• 负责人: Susmita Chowdhuri
• 金额: --
• 依托单位: JOHN D DINGELL VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10356081
• 关键词: Aging; Alzheimer' s Disease; Arousal; Award; Brain; Cardiovascular system; Caring; Catchment Area; Chronic; Chronic Obstructive Pulmonary Disease; Chronic lung disease; Clinical; Cognitive; Cognitive deficits; Complex; Continuous Positive Airway Pressure; Data; Dementia; Disease; Drowsiness; Early treatment; Education; Elderly; Feasibility Studies; Functional disorder; Future; Goals; Health; Healthcare; Hospitals; Hypercapnia; Hypoventilation; Hypoxia; Impaired cognition; Impairment; Individual; Injury; Medical; Memory; Mental Depression; Neurocognitive; Neurocognitive Deficit; Neurodegenerative Disorders; Obstructive Sleep Apnea; Outcome; Pathway interactions; Patients; Pharmacology; Pilot Projects; Population; Prevalence; Quality of life; Questionnaires; Rehabilitation therapy; Research; Research Design; Research Priority; Risk; Short-Term Memory; Sleep; Sleep Disorders; Sleep Fragmentations; Sleep disturbances; Stroke; Symptoms; Syndrome; Time; Veterans; airway obstruction; cognitive enhancement; cognitive function; cognitive testing; comorbidity; disability; effective therapy; effectiveness evaluation; experience; falls; improved; innovation; mild cognitive impairment; military veteran; mortality; novel; poor sleep; positive airway pressure; prospective; randomized controlled study; sleep health; sleep quality; ventilation

Cognitive dysfunction in the aging and elderly Veteran population confers a risk for increased mortality. Cognitive deficits are prevalent in neurodegenerative disorders, like Alzheimer’s disease, stroke, and depression. More recently, obstructive sleep apnea (OSA) has been recognized as a factor contributing to cognitive deficits via intermittent hypoxia and sleep fragmentation. Moreover, chronic lung disease, particularly COPD, is also thought to be related to cognitive decline, possibly through sleep fragmentation and hypoxic injury to the brain. Our pilot project data on the impact of OSA-COPD Overlap Syndrome in older Veterans provides evidence that the presence of comorbid OSA and COPD does contribute to sleep disturbances, impairment in certain domains of cognitive function and an overall reduced quality of life (QoL). Given that PAP therapy has been shown to improve neurocognitive function and sleepiness in moderate to severe OSA, probably by reducing arousals and hypoxia, as well by improving sustained hypoxia due to COPD, it will likely also have a positive impact on sleep and cognitive impairment in patients with moderate to severe degree of Overlap Syndrome. The results from the pilot project speak to the feasibility of conducting a future longer study of the impact of treatment with positive airway pressure therapy (PAP) vs. conservative care in older Veterans with Overlap Syndrome. Our future project builds on the pilot data to study the following aims: Aim1 will investigate the effect of PAP therapy vs. conservative care for 6 months on daytime sleepiness and sleep quality in older Veterans with OVS. Aim 2 will study the effect of PAP vs. conservative care for 6 months on neurocognitive function older Veterans with OVS. Aim 3 will determine the effect of PAP vs. conservative care for 6 months on QoL in older Veterans with OVS. The approach will be a prospective parallel group randomized controlled study, wherein we will administer sleep and QoL questionnaires, and a battery of cognitive tests, before and after 6 mo of PAP therapy or conservative management to evaluate the above outcomes. Our goal is to enhance rehabilitation from comorbid chronic conditions that frequently impact sleep and cognitive function, with the ultimate objective of improving the overall health and quality of life of elderly Veterans suffering from these disorders.

衰老和老年人口的认知功能障碍承认死亡率增加的风险。 认知缺陷在神经退行性疾病中普遍存在，例如阿尔茨海默氏病，中风和 沮丧。最近，阻塞性睡眠呼吸暂停（OSA）被认为是导致的因素 通过间歇性缺氧和睡眠破碎化的认知缺陷。此外，慢性肺病，特别是 COPD也被认为与认知下降有关，通过睡眠破碎和低氧可能 大脑受伤。我们有关OSA-COPD重叠综合征对老年退伍军人的影响的试点项目数据 提供证据表明合并症OSA和COPD的存在确实有助于睡眠障碍， 认知功能的某些领域的损害和总体降低的生活质量（QOL）。鉴于那个帕克 已显示治疗可改善中度至重度OSA中的神经认知功能和嗜睡， 也许还可以减少唤醒和缺氧，也可以通过改善COPD引起的持续缺氧，可能会 对中度至重度的患者的睡眠和认知障碍也有积极的影响 重叠综合征。试点项目的结果表明了进行未来更长的研究的可行性 通过阳性气道压力治疗（PAP）与老年退伍军人的保守护理的影响 与重叠综合征。我们未来的项目以试点数据为基础，以研究以下目的： AIM1将调查PAP疗法与保守护理的影响6个月对白天嗜睡和 带有OV的老年退伍军人的睡眠质量。 AIM 2将研究6个月的PAP与保守护理的影响 关于神经认知功能，具有OVS的老年退伍军人。 AIM 3将决定PAP与保守派的效果 在具有OVS的老年退伍军人的QOL上，请注意6个月。该方法将是一个预期的平行组 随机对照研究，我们将管理睡眠和QOL问卷，以及一部 认知测试，PAP治疗或保守管理6 mo之前和之后评估上述 结果。我们的目标是增强经常影响睡眠的合并症慢性状况的康复 和认知功能，最终目标是改善较早的整体健康和生活质量 退伍军人患有这些疾病。