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

摘要 阻塞性睡眠呼吸暂停（OSA）是一种常见的睡眠障碍，与心血管疾病的风险增加有关。 (CV)疾病然而，由于缺乏有效的治疗方法，OSA的治疗是否能改善CV结局仍不确定。 最近临床试验的证据。我们假设重复性夜间血压 (BP)睡眠呼吸暂停事件后的激增改善了OSA的风险分层，并有助于识别受益者 大部分来自心理治疗阻塞性睡眠呼吸暂停综合征是夜间高血压的主要危险因素， 不良CV结局，包括死亡率。因此，夜间高血压可能是一种 OSA和CV发病率和死亡率之间的中介。然而，持续BP目前尚未量化， 用于OSA评估的临床睡眠研究，而传统的动态血压监测设备， 间歇性测量BP无法捕获与睡眠呼吸暂停事件相关的BP激增。捕捉睡眠 呼吸暂停特异性阵发性BP升高，我们将使用最近验证的基于指套的逐搏BP装置 在多导睡眠图（PSG）中监测夜间血压。在这项时间紧迫的辅助研究中，我们建议 检查睡眠呼吸暂停特异性BP升高与CV风险增加的相关程度 结果（目标1，横断面研究）;以及具有较高睡眠呼吸暂停特异性BP激增的个体是否 在降低CV风险方面，对持续气道正压通气（CPAP）治疗的反应更好 (Aim 2、前瞻性研究）。此外，我们还将研究白色人和非洲人之间的种族差异 美国人睡眠呼吸暂停特异性血压升高的程度以及是否与目的1中检查的相关性有关 和2是由种族（目标3）修改。为达致这些目标，我们会善用 正在进行的NHLBI在Brigham and Women's Hospital赞助的母研究（N~160）中， 正在研究衍生的生理指标，以评估其用于预测对12- 15的CV反应的效用。 持续气道正压通气（CPAP）治疗阻塞性睡眠呼吸暂停综合征（OSA）的临床研究我们将在PSG记录中添加连续逐搏BP监测 在母研究的基线研究时进行。主要CV结局将是左心室应变， 斑点追踪超声心动图是亚临床机械性左心室的敏感指标 功能障碍次要CV结局将包括其他常规超声心动图结构指标 左心房电重构的心电图标志物和动脉僵硬度 脉搏波速度。我们还将招募更多的非洲裔美国人，以便在以下方面有足够的统计能力： 目标3。该建议的主要创新是将连续测量的夜间BP和 其他PSG衍生的生理测量结果用于临床决策。我们的研究设计允许 种族特异性调查，目的是更好地了解OSA与现有CV之间的联系机制 非裔美国人的健康差距。

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.