Sleep Apnea-Specific Nocturnal Blood Pressure Surge to Determine Cardiovascular Risks and Therapeutic Benefits in Patients with Obstructive Sleep Apnea

睡眠呼吸暂停特异性夜间血压升高可确定阻塞性睡眠呼吸暂停患者的心血管风险和治疗效果

• 批准号: 10686068
• 负责人: Younghoon Kwon
• 金额: $ 60.24万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10686068
• 关键词: Accounting; Acute; Address; Affect; African American; African American population; Ambulatory Blood Pressure Monitoring; Ancillary Study; Apnea; Biological Markers; Blood Pressure; Blood Pressure Monitors; Cardiovascular Diseases; Cardiovascular system; Clinical; Clinical Trials; Continuous Positive Airway Pressure; Cross-Sectional Studies; Data; Decision Making; Devices; Disputes; EKG P Wave; Echocardiography; Effectiveness; Electrocardiogram; Enrollment; Evaluation; Event; Fingers; Functional disorder; Goals; Health; Health Benefit; Heart Atrium; Heart Rate; Hospitals; Hypoxemia; Individual; Infrastructure; Investigation; Left; Left Ventricular Dysfunction; Link; Measurement; Measures; Mechanics; Mediator; Methods; Monitor; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Nocturnal Hypertension; Obstructive Sleep Apnea; Outcome; Parents; Participant; Pathway interactions; Patients; Persons; Phenotype; Physiologic pulse; Physiological; Polysomnography; Predisposition; Prevalence; Prognostic Marker; Prospective Studies; Race; Research Design; Resources; Risk Factors; Sample Size; Sampling Studies; Severities; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Specific qualifier value; Testing; Therapeutic; Time; Ventricular; Woman; arterial stiffness; blood pressure elevation; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; caucasian American; clinical decision-making; cost efficient; follow-up; health disparity; high risk population; improved; indexing; innovation; monitoring device; mortality; novel; racial difference; racial health disparity; recruit; respiratory; response; risk stratification; secondary outcome; treatment response; wearable device

Abstract Obstructive sleep apnea (OSA) is a common sleep disorder associated with an increased risk of cardiovascular (CV) disease. However, it remains uncertain whether treatment of OSA improves CV outcomes given the lack of evidence from recent clinical trials. We hypothesize that characterizing repetitive nighttime blood pressure (BP) surges following sleep apnea events improves risk stratification in OSA and helps identify those who benefit most from therapy. OSA is a major risk factor for nocturnal hypertension, a well-established prognostic marker for adverse CV outcomes, including mortality. Therefore, it is plausible that nocturnal hypertension acts as a mediator between OSA and CV morbidity and mortality. However, continuous BP is not currently quantified in clinical sleep studies for OSA evaluation, while the conventional ambulatory BP monitoring device that intermittently measures BP is unable to capture BP surges associated with sleep apnea events. To capture sleep apnea-specific episodic BP increase, we will use a recently validated finger-cuff-based beat-to-beat BP device to monitor nocturnal BP during polysomnography (PSG). In this time-sensitive ancillary study, we propose to examine the extent to which sleep apnea-specific BP increase is associated with an increased risk for CV outcomes (Aim 1, cross-sectional study); and whether individuals with higher sleep apnea-specific BP surges respond more favorably to continuous positive airway pressure (CPAP) therapy in terms of reduction in CV risks (Aim 2, prospective study). In addition, we will examine the race-specific differences between White and African American in the degree of sleep apnea-specific BP increase and whether the associations examined in Aims 1 and 2 are modified by race (Aim 3). To achieve these aims, we will leverage the infrastructure and resources of the ongoing NHLBI sponsored parent study at the Brigham and Women's Hospital (N~160) in which novel PSG- derived physiological metrics are being investigated to evaluate their utilities for predicting CV responses to 12- week CPAP therapy in people with OSA. We will add continuous beat-to-beat BP monitoring to PSG recording performed at the baseline study of the parent study. The primary CV outcome will be left ventricular strain by speckle tracking echocardiography, which is a sensitive marker for subclinical mechanical left ventricular dysfunction. Secondary CV outcomes will include other conventional echocardiographic measures of structural and functional remodeling, electrocardiographic marker of left atrial electrical remodeling and arterial stiffness by pulse wave velocity. We will also recruit additional African Americans to have sufficient statistical power in Aim 3. The major innovation of this proposal is the incorporation of the continuously measured nocturnal BP and other PSG-derived physiological measurements into the clinical decision making. Our study design allows for race-specific investigation with the goal of better understanding the mechanisms linking OSA to the existing CV health disparity in African Americans.

抽象的 阻塞性睡眠呼吸暂停（OSA）是一种与心血管风险增加有关的常见睡眠障碍 （简历）疾病。但是，鉴于缺乏 最近的临床试验证据。我们假设表征重复的夜间血压 （bp）睡眠呼吸暂停事件后的激增可改善OSA的风险分层，并帮助确定受益的人 大多数来自治疗。 OSA是夜间高血压的主要危险因素，这是一个完善的预后标记 对于不良的简历结果，包括死亡率。因此，夜间高血压是一个合理的 OSA与CV发病率和死亡率之间的中介体。但是，当前未量化连续的BP OSA评估的临床睡眠研究，而常规的卧床BP监测装置 间歇性测量BP无法捕获与睡眠呼吸暂停事件相关的BP潮流。捕捉睡眠 特定于呼吸暂停的情节bp增加，我们将使用最近验证的基于手指扣的Beat-Beat BP设备 监测多个夜间BP在多肌仪（PSG）期间。在这项时间敏感的辅助研究中，我们建议 检查睡眠呼吸暂停特异性BP的增加与CV风险增加有关的程度 结果（AIM 1，横断面研究）；以及睡眠呼吸暂停特异性的bp潮流是否较高 在CV风险的降低方面，对连续正气道压力（CPAP）疗法的反应更为有利 （AIM 2，前瞻性研究）。此外，我们将研究白人和非洲之间的特定种族差异 美国的睡眠呼吸暂停特异性BP的增加程度以及目标1中检查的关联是否是否 和2通过种族修改（AIM 3）。为了实现这些目标，我们将利用 正在进行的NHLBI赞助了Brigham and妇女医院（N〜160）的父母研究，其中新颖的PSG- 正在研究衍生的生理指标，以评估其公用事业，以预测CV对12-的响应 OSA患者的周期CPAP治疗。我们将在PSG记录 在父母研究的基线研究中进行。主要的CV结局将通过 斑点跟踪超声心动图，这是亚临床机械左心室的敏感标记 功能障碍。次级简历结果将包括其他常规超声心动图测量 和功能重塑，左心电图的心电图标记和动脉刚度 按脉冲波速度。我们还将招募其他非洲裔美国人，以拥有足够的统计能力 目的3。该提案的主要创新是纳入了连续测量的夜间BP和 其他PSG衍生的生理测量进行了临床决策。我们的研究设计允许 特定于种族的调查，目的是更好地了解将OSA与现有简历联系起来的机制 非裔美国人的健康差异。

项目成果

Recurrent sudden cardiac death secondary to anomalous right coronary artery: Insights into prevalence and management.

• DOI: 10.1177/2050313x221100878
• 发表时间: 2022
• 期刊: SAGE open medical case reports
• 影响因子: 0.8

The burden of sleep disordered breathing in infants with Down syndrome referred to tertiary sleep center.

唐氏综合症婴儿睡眠呼吸障碍的负担转交给三级睡眠中心。

• DOI: 10.1002/ppul.26302
• 发表时间: 2023
• 期刊: Pediatric pulmonology
• 影响因子: 3.1
• 作者: Cho,Yeilim;Kwon,Younghoon;Ruth,Chris;Cheng,Samuel;DelRosso,LourdesM
• 通讯作者: DelRosso,LourdesM

Positional obstructive sleep apnea in patients with atrial fibrillation.

房颤患者的体位性阻塞性睡眠呼吸暂停。

• DOI: 10.1007/s11325-022-02625-y
• 发表时间: 2023
• 期刊: Sleep & breathing = Schlaf & Atmung
• 作者: Stafford,PatrickL;Harmon,Evan;Patel,Paras;Walker,McCall;Akoum,Nazem;Park,Seung-Jung;Cho,Yeilim;Bilchick,Kenneth;Mehta,Nishaki;Mazimba,Sula;Cho,Yoonsik;Kwon,Younghoon
• 通讯作者: Kwon,Younghoon