Nocturnal Hypertension and Sleep

我的整个职业目标是建立一个独立的研究项目，专注于识别小说 减少与夜间高血压相关的发病率和死亡率的干预措施，定义为 在24小时动态血压监测(ABPM)中睡眠时血压升高。培训 计划：在K23职业发展奖申请中，我将获得四个方面的培训，以建立 具有HTN和睡眠专业知识的独立研究计划：模块1：研究方法 HTN包括临床试验，模块2：包括临床试验的睡眠临床和研究培训， 模块3：HTN中的定量方法和高级统计，模块4：研究 传播和向独立的过渡。我已经组建了一支由资深学生组成的多学科团队 在HTN、睡眠研究方面有专长的研究人员(大一·辛博博士、约瑟夫·施瓦茨博士和保罗·蒙特纳博士) (Ari Shechter和Martica Hall博士)、生物统计学(Schwartz博士)和随机对照试验(RCT)(Dr. Schwartz和Shechter)，他们将定期与我会面，以确保我在研究方面取得进展 和培训目标，以及整体的职业发展。研究计划：睡眠血压水平较高的人 靶器官损害和心血管疾病(CVD)事件的风险增加。短时睡眠 持续时间(SSD)定义为每晚睡眠少于7小时，发生在超过30%的成年人中，并且与 增加了患心血管疾病的风险。横断面研究表明，SSD与睡眠增加有关 血压水平可能是由于交感神经活动增加和副交感神经活动减少所致。这就做 进行随机对照试验，以确定8周延长睡眠干预对睡眠血压的影响 66名SSD患者的24小时动态血压监测。参与者将随机接受延长睡眠时间(经过验证的 睡眠卫生教育干预)，目标是在8周内将睡眠时间增加1小时，如 通过腕部活动描记(n=33)和对照条件(睡眠生理学教育；n=33)进行评估。参与者 将在24小时内对交感神经和副交感神经活动进行24小时动态血压监测和标准化评估- 基线和8周后每小时ABPM。我将确定睡眠延长是否与 降低平均睡眠收缩压，其次是平均睡眠舒张压(主要目标)。我会检查一下 睡眠时间延长是否与交感神经活动减少和睡眠质量增加有关 从基线到8周的副交感神经活动(次级目标1)。在什么程度上减少 平均睡眠收缩压与睡眠延长干预的解释是交感神经和 副交感神经活动也将被检查(次要目标2)。对主要目标的分析也将 根据夜间HTN和基线时睡眠质量状况差进行分层(探索性目标)。这项研究将 为我计划在HTN和SLEEP的职业生涯奠定坚实的基础，以及未来的R01提案审查 睡眠时间延长是否能降低因睡眠血压水平升高而增加的心血管疾病风险。

My overall career goal is to establish an independent program of research focusing on identifying novel interventions to decrease the morbidity and mortality associated with nocturnal hypertension (HTN), defined as having elevated blood pressure (BP) during sleep on 24-hour ambulatory BP monitoring (ABPM). Training plan: In the K23 Career Development Award application, I will obtain training in four areas in order to build an independent program of research with an expertise in HTN and sleep: Module 1: Research Methodology in HTN including Clinical Trials, Module 2: Clinical and Research Training in Sleep including Clinical Trials, Module 3: Quantitative Methodologies and Advanced Statistics in HTN, and Module 4: Research Dissemination and Transition to Independence. I have assembled a multidisciplinary team of senior investigators with expertise in HTN (Drs. Daichi Shimbo, Joseph Schwartz, and Paul Muntner), sleep research (Drs. Ari Shechter and Martica Hall), biostatistics (Dr. Schwartz), and randomized controlled trials (RCTs) (Drs. Schwartz and Shechter) who will meet regularly with me to ensure that I am progressing towards my research and training goals, and overall career development. Research plan: Individuals with higher sleep BP levels are at an increased risk of target organ damage and cardiovascular disease (CVD) events. Short sleep duration (SSD) defined as sleeping less than 7 hours per night, occurs in over 30% of adults, and is associated with an increased risk for CVD. Cross-sectional studies have shown that SSD is associated with elevated sleep BP levels which may be due to increased sympathetic activity and reduced parasympathetic activity. I will conduct a RCT to determine the effect of an 8-week sleep extension intervention on sleep BP as assessed on 24-hour ABPM among 66 individuals with SSD. Participants will be randomized to sleep extension (a validated sleep hygiene education intervention), aiming to increase sleep duration by up to 1 hour over 8 weeks as assessed by wrist actigraphy (n=33) vs. a control condition (education on sleep physiology; n=33). Participants will have 24-hour ABPM and standardized assessment of sympathetic and parasympathetic activity during 24- hour ABPM at baseline and 8 weeks later. I will determine whether sleep extension is associated with a reduction in mean sleep systolic BP, and secondarily, mean sleep diastolic BP (Primary Aim). I will examine whether sleep extension is associated with a reduction in sympathetic activity and an increase in parasympathetic activity from baseline to 8 weeks (Secondary Aim 1). The degree to which a reduction in mean sleep systolic BP with the sleep extension intervention is explained by a reduction in sympathetic and parasympathetic activity will also be examined (Secondary Aim 2). The analyses for the Primary Aim will also be stratified by nocturnal HTN and poor sleep quality status at baseline (Exploratory Aim). This study will provide a strong foundation for my planned career in HTN and sleep, and a future R01 proposal examining whether sleep extension reduces the increased CVD risk associated with higher sleep BP levels.