Nocturnal Hypertension and Sleep

夜间高血压与睡眠

• 批准号: 10434815
• 负责人: Marwah Abdalla
• 金额: $ 19.1万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10434815
• 关键词: Adult; Affect; Ambulatory Blood Pressure Monitoring; Antihypertensive Agents; Area; Biometry; Blood Pressure; Cardiovascular Diseases; Clinic; Clinical Research; Clinical Trials; Communities; Control Groups; Cross-Sectional Studies; Data; Diastolic blood pressure; Education; Educational Intervention; Ensure; Event; Foundations; Frequencies; Future; Goals; Hour; Hypertension; Individual; Inpatients; Intervention; K-Series Research Career Programs; Link; Measurement; Methodology; Monitor; Morbidity - disease rate; Nocturnal Hypertension; Norepinephrine; Organ; Participant; Pharmaceutical Preparations; Phenotype; Photoplethysmography; Prevalence; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recording of previous events; Research; Research Methodology; Research Personnel; Research Training; Risk; Risk Factors; Sleep; Standardization; Training; Wrist; actigraphy; awake; blood pressure elevation; cardiovascular disorder risk; career; career development; deprivation; design; digital; effective intervention; experience; heart rate variability; improved; modifiable risk; mortality; multidisciplinary; novel; poor sleep; programs; research data dissemination; sleep health; sleep physiology; sleep quality; statistics; urinary

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.

我的总体职业目标是建立一个独立的研究项目，专注于识别新的 降低夜间高血压（HTN）相关发病率和死亡率的干预措施，定义为 睡眠期间24小时动态血压监测（ABPM）显示血压（BP）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 一个独立的研究计划，具有HTN和睡眠方面的专业知识：模块1： HTN包括临床试验，模块2：睡眠临床和研究培训，包括临床试验， 模块3：HTN中的定量方法和高级统计，以及模块4：研究 传播和向独立过渡。我召集了一个多学科的团队， HTN研究专家（Daichi Shimbo，Joseph Schwartz和Paul Muntner博士），睡眠研究 (Drs. Ari Shechter和Martica Hall）、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，以确保我的研究取得进展 培训目标和整体职业发展。研究计划：睡眠血压水平较高的人 靶器官损伤和心血管疾病（CVD）事件的风险增加。短睡眠 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 患心血管疾病的风险增加横断面研究表明，SSD与睡眠水平升高有关 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。我会 进行随机对照试验，以确定8周睡眠延长干预对睡眠血压的影响， 24-对66例SSD患者进行了24 h动态血压监测。参与者将被随机分配到睡眠延长组（一个经过验证的 睡眠卫生教育干预），旨在8周内增加睡眠时间1小时， 通过腕关节活动记录仪（n=33）与对照条件（睡眠生理学教育; n=33）进行评估。参与者 将进行24小时ABPM，并在24小时内对交感神经和副交感神经活动进行标准化评估。 在基线和8周后的24小时ABPM。我将确定睡眠延长是否与 平均睡眠收缩压降低，其次是平均睡眠舒张压降低（主要目的）。我将研究 睡眠延长是否与交感神经活动的减少和 副交感神经活性从基线至8周（次要目的1）。减少的程度 平均睡眠收缩压与睡眠延长干预解释为减少交感神经和 还将检查副交感神经活动（次要目的2）。对主要目标的分析还将 根据夜间HTN和基线时的睡眠质量状况进行分层（探索性目的）。本研究将 为我计划的HTN和睡眠职业生涯奠定了坚实的基础，并为未来的R 01提案进行了审查 延长睡眠时间是否能降低与较高睡眠血压水平相关的心血管疾病风险。