Cognition After OSA Treatment Among Native American People

美洲原住民接受 OSA 治疗后的认知

基本信息

批准号：
10667558
负责人：
KA'IMI ALOHILANI SINCLAIR
金额：
$ 41.36万
依托单位：
WASHINGTON STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-01 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10667558
关键词：
Adherence Age Alzheimer&apos s Disease Alzheimer&apos s disease patient Alzheimer&apos s disease related dementia Alzheimer&apos s disease risk American Indians Amyloid beta-Protein Apnea Arizona Attention Behavior Therapy Behavioral Biological Markers Body Weight decreased Breathing Cardiovascular Diseases Cerebrospinal Fluid Cerebrovascular Disorders Clinical Trials Cognition Cohort Studies Communities Complex Data Data Collection Dementia Development Diabetes Mellitus Diagnosis Diagnostic Equipment Disease Disparity Effectiveness of Interventions Elderly Electronics Eligibility Determination Epidemiology Excessive Daytime Sleepiness Executive Dysfunction FDA approved Family Study Functional disorder Healthcare Heart High Prevalence Home Hour Hypertension Impaired cognition Individual Intervention Link Long-Term Effects Magnetic Resonance Imaging Measures Mediating Meta-Analysis Minority Minority Groups Native Americans Neurologic Obesity Observational epidemiology Obstruction Obstructive Sleep Apnea Oklahoma Outcome Participant Patients Persons Polysomnography Population Population Study Positron-Emission Tomography Prevalence Prevention program Protocols documentation Qualitative Methods Randomized Randomized, Controlled Trials Reporting Research Research Project Grants Reservations Risk Risk Factors Site Sleep Sleep Apnea Syndromes Sleep Disorders South Dakota Symptoms Testing Time Vascular Diseases abeta deposition base behavior test brain morphology cognitive change cognitive function cohort dementia risk effectiveness evaluation evidence base executive function experience frontier improved improvement on sleep low socioeconomic status member mild cognitive impairment motivational enhancement therapy novel population based positive airway pressure pragmatic randomized trial pragmatic trial pressure primary outcome recruit sleep position sleep quality standard care treatment adherence treatment as usual vascular risk factor

项目摘要

RESEARCH PROJECT 3: ABSTRACT Prevalence of obstructive sleep apnea (OSA) among older adults in the US is as high as 56%. Short-term neurological consequences of OSA include cognitive changes such as poor attention and impaired executive function, although the mechanisms for these associations are unclear. OSA also increases risk of Alzheimer’s disease and related dementias (ADRD) and mild cognitive impairment, as well as alters ADRD biomarkers. Positive airway pressure is the gold standard treatment for OSA and improves cognition in clinical trials, including patients with ADRD. Although American Indians have a high prevalence of obesity, a risk factor for both OSA and ADRD, no reliable population-based estimates of OSA prevalence exist for AIs. OSA also is likely underdiagnosed in American Indians, and data strongly suggest a disparity in this modifiable ADRD risk factor. Accordingly, we will generate population-based estimates of OSA prevalence and its association with cognitive function, develop a novel intervention, and conduct a randomized pragmatic trial. For the epidemiology component, we will recruit members of 2 studies affiliated with the Strong Heart Study, the only population-based study of cardiovascular and cerebrovascular disease in American Indians. We will screen 450 cohort members ages 55+ living on 2 Northern Plains reservations for OSA and measure cognitive function. Participants with suspected OSA will undergo testing with the WATCHPAT, an FDA-approved sleep apnea diagnostic device. Participants whose results confirm OSA will be referred for positive airway pressure therapy and be eligible for the trial. Analyses will leverage previously collected data to identify fixed and time- varying risk factors for OSA. Next, we will develop the behavioral intervention by using qualitative methods to revise existing protocols for motivational interviewing and electronic messaging to increase pressure treatment adherence. For the randomized controlled trial, we will recruit 300 American Indians ages 55+ from the same Strong Heart Study communities who receive positive airway pressure treatment for OSA. They will be randomized to receive usual care, or usual care plus the intervention. Data collection at baseline, 3 months and 12 months will include positive airway pressure adherence, sleep quality, cognitive function, and vascular risk factors for ADRD. Primary outcomes are positive airway pressure adherence and cognitive function, with the former evaluated as a mechanistic explanation for change in the latter. Our Specific Aims are to: 1) Estimate the prevalence of OSA and its association with cognitive function in older American Indians, and identify OSA risk factors from existing longitudinal data collected by the 2 Strong Heart-Study-affiliated studies; 2) Develop the behavioral intervention and test its effect on positive airway pressure adherence and sleep quality; and 3) Assess the intervention’s effectiveness on cognitive function and ADRD vascular risk factors. This unique study explores the relationship between OSA and cognitive function in an understudied, at-risk, frontier population with limited access to specialized healthcare. It also takes an important step toward evaluating OSA as a mechanism for the strong association between OSA and ADRD.

研究项目 3：摘要美国老年人中阻塞性睡眠呼吸暂停 (OSA) 的患病率短期高达 56%。 OSA 的神经系统后果包括认知改变，例如注意力不集中和执行力受损尽管这些关联的机制尚不清楚，但 OSA 也会增加患阿尔茨海默病的风险。疾病及相关痴呆 (ADRD) 和轻度认知障碍，以及改变 ADRD 生物标志物。气道正压通气是治疗 OSA 的金标准，可改善临床试验中的认知能力，尽管美国印第安人的肥胖率很高，但肥胖是 ADRD 的一个危险因素。对于 OSA 和 ADRD，对于 OSA 患病率也没有可靠的基于人群的估计。美洲印第安人可能没有得到充分诊断，数据强烈表明这种可改变的 ADRD 风险存在差异因此，我们将生成基于人群的 OSA 患病率及其与 OSA 的关联的估计值。认知功能，开发新的干预措施，并进行随机实用试验。流行病学部分，我们将招募隶属于“强心脏研究”的 2 个研究的成员，这是唯一一个我们将对美洲印第安人的心脑血管疾病进行基于人群的研究。居住在 2 个北部平原 OSA 保留地的 450 名年龄 55 岁以上的队列成员测量认知能力怀疑患有 OSA 的参与者将接受 WATCHPAT（一种经 FDA 批准的睡眠）测试。呼吸暂停诊断设备的结果确认 OSA 的参与者将被转介进行气道正压通气治疗。治疗并符合试验资格的分析将利用之前收集的数据来确定固定的和时间性的。接下来，我们将通过使用定性方法来制定行为干预措施。修改现有的动机访谈和电子消息协议以增加压力治疗对于随机对照试验，我们将从美国招募 300 名 55 岁以上的印第安人。接受气道正压通气治疗的 OSA 患者将是同样的强心脏研究社区。随机接受常规护理，或常规护理加干预措施，为期 3 个月。 12 个月将包括气道正压依从性、睡眠质量、认知功能和血管 ADRD 的主要危险因素是气道正压通气依从性和认知功能。前者被评估为后者变化的机械解释，我们的具体目标是：1）。估计美国老年印第安人中 OSA 的患病率及其与认知功能的关系，以及从 2 项 Strong Heart-Study 附属研究收集的现有纵向数据中确定 OSA 危险因素； 2) 制定行为干预措施并测试其对气道正压依从性和睡眠的影响质量；3) 评估干预措施对认知功能和 ADRD 血管危险因素的有效性。这项独特的研究探讨了 OSA 与认知功能之间的关系，该研究尚未得到充分研究，存在风险，获得专业医疗服务有限的边境人口也朝着这一目标迈出了重要的一步。评估 OSA 作为 OSA 与 ADRD 之间强关联的机制。