Cognition After OSA Treatment Among Native American People

研究项目3：摘要 美国老年人中阻塞性睡眠呼吸暂停（OSA）的患病率高达56%。短期 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。 虽然这些协会的机制尚不清楚，但这些协会的职能仍然存在。阻塞性睡眠呼吸暂停也会增加患老年痴呆症的风险 疾病和相关痴呆（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OSA的金标准治疗，在临床试验中可改善认知， 包括ADRD患者。虽然美国印第安人肥胖的患病率很高，但肥胖的一个危险因素是， 对于OSA和ADRD，没有可靠的基于人群的OSA患病率估计。OSA也是 在美国印第安人中可能诊断不足，数据强烈表明这种可改变的ADRD风险存在差异 因子因此，我们将产生基于人群的OSA患病率的估计值及其与 认知功能，开发一种新的干预措施，并进行随机实用试验。为 流行病学组成部分，我们将招募2个研究的成员与强大的心脏研究，唯一的 美国印第安人心脑血管疾病的人群基础研究。我们将筛选 450名年龄在55岁以上的队列成员，居住在2个北方平原的OSA保留区，并测量认知功能 功能患有疑似OSA的参与者将接受WATCHPAT测试，这是一种FDA批准的睡眠 呼吸暂停诊断装置。结果证实OSA的受试者将被转诊接受气道正压通气 治疗并有资格参加试验。分析将利用以前收集的数据，以确定固定和时间- 不同的OSA风险因素。接下来，我们将通过使用定性方法开发行为干预， 修改现有的激励性面谈和电子信息传递协议，以增加压力治疗 坚持。在随机对照试验中，我们将招募300名年龄在55岁以上的美国印第安人， 同样的强心研究社区谁接受气道正压通气治疗OSA。他们将 随机接受常规护理或常规护理加干预。基线、3个月时的数据收集 12个月将包括气道正压通气坚持、睡眠质量、认知功能和血管 ADRD的危险因素。主要结局是气道正压通气依从性和认知功能， 前者被评价为后者变化的机械解释。我们的具体目标是：1） 估计OSA的患病率及其与老年美洲印第安人认知功能的关系， 从2项强心研究附属研究收集的现有纵向数据中识别OSA风险因素; 2)开展行为干预并检测其对气道正压通气依从性和睡眠的影响 评估干预对认知功能和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， 获得专业医疗服务有限的边境人口。它也迈出了重要一步， 评估OSA作为OSA和ADRD之间强关联的机制。

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.