Novel physiologiC prEdictors of Positive Airway Pressure effectiveness: NICE-PAP study.

气道正压有效性的新型生理预测因素：NICE-PAP 研究。

基本信息

批准号：
10685994
负责人：
ANDREY ZINCHUK
金额：
$ 17.23万
依托单位：
YALE 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：
2021-09-01 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10685994
关键词：
Accounting Acetazolamide Address Adherence Adult Affect Age American Anatomy Apnea Arousal Atrial Fibrillation Automobile Driving Biological Biometry Breathing Catheters Clinical Pathways Clinical Research Clinical Trials Design Compensation Complement Continuous Positive Airway Pressure Critical Care Data Data Set Development Plans Diabetes Mellitus Diagnosis Drowsiness Effectiveness Engineering Environment Epidemiology Equipment Exhibits Expectancy Future Goals Growth Heart failure Hour Hypertension Impairment Individual Infrastructure Institution Internal Medicine Knowledge Laboratories Link Lung Measurement Measures Medicine Mentored Patient-Oriented Research Career Development Award Mentors Methodology Modification Morbidity - disease rate Myocardial Infarction Obstructive Sleep Apnea Outcome Oxygen Pathogenesis Patient Care Patient-Focused Outcomes Patients Pharyngeal structure Physicians Physiological Physiology Polysomnography Predisposition Prospective cohort Psychological Factors Psychosocial Factor Pulmonology Quality of life Research Research Methodology Research Personnel Research Project Grants Research Training Residual state Resources Risk Role Science Scientist Self Efficacy Sleep Sleep Apnea Syndromes Sleeplessness Social support Stroke Symptoms Techniques Training Training Activity Training Programs Translating Work career development clinical application clinical epidemiology cohort common treatment design epidemiology study experience externship hypnotic improved ineffective therapies mortality novel novel strategies patient oriented patient oriented research personalized care personalized medicine pharynx muscle poor sleep positive airway pressure pressure prevent programs prospective psychologic randomized trial randomized, clinical trials remote monitoring response sex skills sleep position sleep quality social social factors success symptomatic improvement tool trait treatment adherence vehicular accident

项目摘要

Candidate. My goal is to become an independent physician-scientist who merges physiology and patient-ori- ented research methods to personalize care for patients with obstructive sleep apnea (OSA). My training as an engineer and a doctor in Pulmonary, Critical Care and Sleep Medicine (PCCSM), complemented by research training in epidemiology, have given me the background necessary to pursue this goal. I propose training activ- ities that will allow me to personalize treatments for one of the most pressing problems for OSA patients- effec- tiveness of continuous positive airway pressure (CPAP). Through coursework, externships and mentored expe- rience in physiologic and patient-oriented research, this training program will build skills and knowledge in 1) physiologic characterization of OSA, 2) treatment adherence, efficacy and patient-oriented outcomes, 3) conduct of clinical studies, 4) advanced biostatistics and 5) leading a research program. Executing this program will bridge current knowledge gaps related to the role of physiologic traits in CPAP effectiveness and set me up for success as an independent investigator. Mentors and Environment. I have engaged an exceptional team of mentors with expertise tailored for this proposal. My primary mentor, Dr. Yaggi, is a national expert in OSA epidemiology and clinical study conduct. My co-mentors are Dr. Wellman, a pioneer in translational OSA physiology, and Dr. Redeker, a leader in patient- centered outcomes sleep research. This proposal leverages a wealth of resources across institutions, including Yale’s Center for Precision Pulmonary Medicine and Clinical Epidemiology Research Center, Centers for Sleep Medicine, PCCSM Section and Internal Medicine Department. The Sleep Disordered Breathing laboratory led by Dr. Wellman at Harvard is a renowned OSA physiology center. This environment provides methodologic expertise, research tools and a venue to conduct cutting-edge patient-oriented research in sleep. Mentored Research Project. Most patients with OSA who are prescribed the gold-standard therapy, CPAP, are ineffectively treated. This is due to 1) poor CPAP adherence, 2) high residual apnea in 20% of users (low efficacy) and 3) inconsistent symptom improvement. To improve CPAP effectiveness, we propose to address novel phys- iologic targets that cause OSA in each individual: arousability, ventilatory control sensitivity and pharyngeal mus- cle compensation. Our overall objective is to determine the contribution of these traits to CPAP effectiveness independently of established biological, psychological and social predictors. This work leverages state-of-the art sleep study analysis tools and validated measures of the determinants of CPAP effectiveness to create a prag- matic, prospective cohort (n=267) of OSA patients. This unique dataset will help determine whether physiologic causes of OSA influence CPAP adherence, efficacy, sleep quality, symptoms, function and quality of life. The results will inform design and conduct of a randomized clinical trial designed to modify physiologic traits such as easy arousability to improve CPAP effectiveness and other patient-centered outcomes in OSA patients.

我的目标是成为一名融合生理学和患者导向的独立医生科学家。我的研究方法是对阻塞性睡眠呼吸暂停 (OSA) 患者进行个性化护理。肺科、重症监护和睡眠医学 (PCCSM) 工程师和医生，并辅以研究流行病学培训为我提供了实现这一目标所需的背景，我建议积极开展培训。这些功能将使我能够针对 OSA 患者最紧迫的问题之一进行个性化治疗 - 效果 - 通过课程作业、实习和指导经验，了解持续气道正压通气 (CPAP) 的有效性。生理学和以患者为导向的研究，该培训计划将培养以下方面的技能和知识：1) OSA 的生理特征，2) 治疗依从性、疗效和以患者为导向的结果，3) 行为临床研究，4）先进的生物统计学和5）领导一个研究项目将。弥合当前与生理特征在 CPAP 有效性中的作用相关的知识差距，并为我做好准备作为独立调查员的成功。导师和环境我聘请了一支具有专门知识的优秀导师团队。我的主要导师 Yaggi 博士是 OSA 流行病学和临床研究行为方面的国家专家。共同导师是转化 OSA 生理学领域的先驱 Wellman 博士和患者领域的领导者 Redeker 博士。该提案利用了各机构的丰富资源，包括耶鲁大学精准肺医学中心和临床流行病学研究中心、睡眠中心医学部、PCCSM 科和内科部由睡眠呼吸障碍实验室领导。哈佛大学的 Wellman 博士是著名的 OSA 生理学中心，这种环境提供了方法论。专业知识、研究工具和场所，以进行以患者为中心的前沿睡眠研究。大多数接受金标准治疗 CPAP 治疗的 OSA 患者均接受指导研究项目。这是由于 1) 持续气道正压通气 (CPAP) 治疗依从性差，2) 20% 的使用者存在高残留呼吸暂停（疗效低）。 3) 症状改善不一致，为了提高 CPAP 的有效性，我们建议解决新的物理问题。引起每个人 OSA 的生理目标：觉醒能力、通气控制敏感性和咽肌我们的总体目标是确定这些特征对 CPAP 有效性的贡献。独立于已建立的生物、心理和社会预测因素，这项工作利用了最先进的技术。睡眠研究分析工具和经过验证的 CPAP 有效性决定因素的测量方法，以创建实用的 OSA 患者的前瞻性队列 (n=267) 这个独特的数据集将有助于确定是否有生理学原因。 OSA 的原因影响 CPAP 的依从性、疗效、睡眠质量、症状、功能和生活质量。结果将为随机临床试验的设计和实施提供信息，该试验旨在改变生理特征，例如易于唤醒，以提高 OSA 患者的 CPAP 有效性和其他以患者为中心的结果。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Periodic limb movements during sleep and risk of hypertension: A systematic review.

睡眠期间的周期性肢体运动和高血压风险：系统评价。

DOI：
发表时间：
2023-02
期刊：
影响因子：
4.8
作者：
Srivali, Narat;Thongprayoon, Charat;Tangpanithandee, Supawit;Krisanapan, Pajaree;Mao, Michael A;Zinchuk, Andrey;Koo, Brain B;Cheungpasitporn, Wisit
通讯作者：
Cheungpasitporn, Wisit

Nicotine, alcohol, and caffeine use among individuals with untreated obstructive sleep apnea.

未经治疗的阻塞性睡眠呼吸暂停患者使用尼古丁、酒精和咖啡因的情况。

DOI：
发表时间：
2023-12
期刊：
影响因子：
0
作者：
Baldassarri, Stephen R;Chu, Jen;Deng, Annan;Xu, Zhichao;Blohowiak, Reagan F;Byrne, Sean;Kushida, Clete;Yaggi, H Klar;Zinchuk, Andrey
通讯作者：
Zinchuk, Andrey

Sleep Deficiency in Obstructive Sleep Apnea.

阻塞性睡眠呼吸暂停中的睡眠不足。