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，目前尚不确定阻塞性睡眠呼吸暂停综合征的治疗是否能改善心血管预后。 来自最近临床试验的证据。我们假设重复性夜间血压的特征 (BP)睡眠呼吸暂停事件后的激增改善了OSA的风险分层，并有助于确定受益者 大部分来自心理治疗。OSA是夜间高血压的主要危险因素，是一个公认的预后标志 对于不良的心血管结果，包括死亡率。因此，夜间高血压似乎是一种 阻塞性睡眠呼吸暂停综合征与心血管疾病发病率和死亡率之间的中介作用。然而，连续BP目前并未在 临床睡眠研究用于OSA评估，而常规的动态血压监测设备 断断续续地测量BP无法捕获与睡眠呼吸暂停事件相关的BP激增。捕捉睡眠 呼吸暂停特定的阵发性血压升高，我们将使用最近验证的基于手指袖带的节拍BP设备 目的：监测多导睡眠图(PSG)中的夜间血压。在这项对时间敏感的辅助研究中，我们建议 检查与睡眠呼吸暂停相关的血压升高与心血管疾病风险增加的关系 结果(目标1，横断面研究)；以及睡眠呼吸暂停程度较高的个体是否会出现血压激增 在降低心血管风险方面，对持续气道正压(CPAP)治疗的反应更有利 (目标2，前瞻性研究)。此外，我们还将研究白人和非洲人之间的种族差异 美国人在睡眠呼吸暂停程度方面的特定血压增加是否与AIMS 1中检查的关联有关 和2个被RACE修饰(目标3)。为了实现这些目标，我们将利用 正在进行的NHLBI赞助的布里格姆妇女医院(N~160)的父母研究中，新的PSG- 正在对衍生的生理指标进行研究，以评估它们在预测12岁以下儿童的心血管反应方面的效用。 阻塞性睡眠呼吸暂停患者的每周CPAP治疗。我们将在PSG记录中增加连续的心跳与心跳血压监测 在母体研究的基线研究中执行。主要心血管事件的结局将是左心室劳损。 斑点跟踪超声心动图是亚临床机械左心室的敏感指标 功能障碍。二次心血管检查结果将包括其他常规超声心动图测量 功能重构、左房电重构和动脉僵硬的心电图标志物 脉搏波速度。我们还将招募更多的非裔美国人，以便在 目的3.本方案的主要创新之处在于纳入了连续测量的夜间血压和 PSG衍生的其他生理测量用于临床决策。我们的研究设计允许 针对特定种族的调查，目的是更好地了解OSA与现有CV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.