Cognition After OSA Treatment Among Native American People

美洲原住民接受 OSA 治疗后的认知

• 批准号: 10172086
• 负责人: KA'IMI ALOHILANI SINCLAIR
• 金额: $ 42.77万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 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/10172086
• 关键词: Adherence; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; American Indians; Amyloid beta-Protein; Amyloid deposition; 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; Devices; Diabetes Mellitus; Diagnosis; Diagnostic; Disease; Effectiveness of Interventions; Elderly; Epidemiology; Excessive Daytime Sleepiness; Executive Dysfunction; FDA approved; Family Study; Functional disorder; Gold; Healthcare; Heart; High Prevalence; Home; Hour; Hypertension; Impaired cognition; Individual; Intervention; Link; Long-Term Effects; Magnetic Resonance Imaging; Measures; Mediating; Meta-Analysis; Minority Groups; Native Americans; Neurologic; Obesity; Observational epidemiology; Obstruction; Obstructive Sleep Apnea; Oklahoma; Outcome; Participant; Patients; 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; base; behavior test; brain morphology; cognitive change; cognitive development; cognitive function; cohort; dementia risk; effectiveness evaluation; evidence base; executive function; experience; frontier; improved; low socioeconomic status; member; mild cognitive impairment; motivational enhancement therapy; northern plains; novel; population based; pragmatic trial; pressure; primary outcome; recruit; sleep position; sleep quality; standard care; treatment adherence; treatment as usual; vascular risk factor

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）的患病率高达56％。短期 OSA的神经系统后果包括认知变化，例如注意力不佳和执行人员受损 功能，尽管这些关联的机制尚不清楚。 OSA还增加了阿尔茨海默氏症的风险 疾病和相关痴呆症（ADRD）和轻度认知障碍，以及改变ADRD生物标志物。 正气道压力是OSA的黄金标准治疗方法，并改善了临床试验的认知， 包括ADRD的患者。尽管美洲印第安人的肥胖症患病率很高，但是一个危险因素 OSA和ADRD都没有可靠的基于人群的OSA患病率的可靠估计。 OSA也是 在美洲印第安人中可能诊断不足，数据强烈表明这种可修改的ADRD风险有差异 因素。彼此之间，我们将产生基于人群的OSA患病率及其与之关联的估计。 认知功能，开发新的干预措施，并进行随机的务实试验。为了 流行病学组成部分，我们将招募2项研究成员，该研究有强大的心脏研究，唯一 基于人群的美国印第安人心血管和脑血管疾病的研究。我们将筛选 450名队列成员55岁以上的居住在2个北部平原预订的OSA并测量认知 功能。怀疑OSA的参与者将与watchpat进行测试，这是FDA批准的睡眠 呼吸暂停设备。结果证实将转介OSA的参与者以呈正气道压力 治疗并有资格参加试验。分析将利用先前收集的数据来识别固定和时间 - OSA的不同风险因素。接下来，我们将通过使用定性方法来开发行为干预 修改现有的动机访谈和电子消息方案以增加压力处理 坚持。对于随机对照试验，我们将招募300名55岁以上的美国印第安人 同样的强大心脏研究社区，他们接受OSA的阳性气道压力治疗。他们会的 随机接受通常的护理或通常的护理以及干预措施。基线的数据收集3个月 12个月将包括正气道压力依从性，睡眠质量，认知功能和血管 ADRD的风险因素。主要结果是正气道压力依从性和认知功能， 前者被评估为后来变化的机械解释。我们的具体目的是：1） 估计OSA的流行及其与年长的美国印第安人的认知功能的关联，以及 从2个强大的心脏研究相关研究收集的现有纵向数据中确定OSA风险因素； 2）开发行为干预并测试其对正气道粘附和睡眠的影响 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和认知功能之间的关系 边境人口有限获得专业医疗保健。这也迈出了重要的一步 评估OSA作为OSA与ADRD之间牢固关联的机制。