CARDIOVASCULAR CONSEQUENCES OF SLEEP APNEA

累积的数据表明睡眠呼吸暂停和轻度睡眠- 相关性呼吸障碍（SRBD）可能在 心血管疾病然而，证据远非决定性的， 主要依靠SRBD的替代措施和病例对照设计。的 该项目的主要目标是前瞻性地调查 心血管疾病的SRBD，采用多中心队列设计。 作为社区动脉粥样硬化风险（ARIC）研究的一部分， 动脉粥样硬化和心血管疾病的人群队列研究 疾病，申请人招募并检查了4，009名男性和女性 1987-1989年在明尼阿波利斯郊区参与者接受了第二次 1990年至1992年举行了一次考试，目前正在进行第三次考试。 （1993-1995年）。1996-1998年的第四次考试已获得资助。广泛的 生活方式、生化、生理和临床特征， 测量包括颈动脉内膜中层厚度， 早期动脉粥样硬化的指标。该队列被随访， 动脉粥样硬化进展和心血管终点。所有这些 这些特征使ARIC明尼阿波利斯队列适合多中心 睡眠研究。 该项目有五个具体目标。首先，申请人将 通过邮寄问卷的方式，对3 828名考试2返回者进行筛选， SRBD相关特征，如习惯性打鼾，观察到的呼吸暂停， 和白天嗜睡。第二，1,000个同意的人的子集- 500名男性和500名女性无临床心血管疾病-将 招募了一个家庭过夜睡眠研究，以获得一个呼吸暂停低通气 得分为了增加研究的统计功效，样本将 通过对习惯性打鼾者进行过采样来富集具有SRBD的个体。 第三，总共250名参与者（估计200名检测呈阳性， SRBD和50测试阴性）将在睡眠中接受多导睡眠描记术 实验室：1）验证诊断，2）更好地量化SRBD，以及3） 计算家庭研究的敏感性和特异性。四是 05年，申请人将测试，跨部门，具体的假设 与：1）SRBD和无症状颈动脉粥样硬化; 2） SRBD与血压; 3）SRBD与胰岛素替代的应用 治疗; 4）SRBD和认知功能; 5）习惯性打鼾和 无症状的颈动脉粥样硬化; 6）习惯性打鼾和流行 心血管疾病第五个也是长期目标是测试， 充分随访，SRBD是否与动脉粥样硬化相关 进展，并伴随心血管疾病的后续风险。 拟议项目的优势在于：1）多学科团队， 经验丰富的心血管流行病学家，睡眠研究人员， 生物统计学家，以及2）已经建立的基于人群的队列 高反应率和详细的心血管风险测量 因素、早期动脉粥样硬化和心血管疾病终点。它 因此，这将是一个重要的和具有成本效益的贡献， 多中心睡眠研究

Accumulated data suggest that sleep apnea and milder forms of sleep- related breathing disorders (SRBD) may have an etiologic role in cardiovascular disease. The evidence, however, is far from conclusive, relying mostly on surrogate measures of SRBD and case-control designs. The broad goal of this project is to investigate, prospectively, the role of SRBD in cardiovascular disease, employing a multi-center cohort design. As part of the Atherosclerosis Risk in Communities (ARIC) Study, a population-based cohort study of atherosclerosis and cardiovascular disease, the applicants have recruited and examined 4,009 men and women from suburban Minneapolis in 1987-1989. Participants underwent a second exam in 1990-1992 and are currently being examined for the third time (1993-1995). A fourth exam in 1996-1998 has been funded. A wide range of lifestyle, biochemical, physiological, and clinical characteristics has been measured, including carotid artery intimal-medial thickness, a measure of early atherosclerosis. The cohort is followed for atherosclerosis progression and cardiovascular endpoints. All of these features make the ARIC Minneapolis cohort suitable for the multi-center Sleep Study. There are five specific aims for this project. First, the applicants will screen the 3,828 exam 2 returnees, by means of a mailed questionnaire, for SRBD-associated characteristics such as habitual snoring, observed apnea, and daytime somnolence. Second, a subset of 1,000 consenting individuals - 500 men and 500 women free of clinical cardiovascular disease - will be recruited for a home overnight Sleep Study to derive an apnea-hypopnea score. To increase the study's statistical power, the sample will be enriched with individuals having SRBD by over-sampling habitual snorers. Third, a total of 250 participants (an estimated 200 testing positive for SRBD and 50 testing negative) will undergo polysomnography in a Sleep Laboratory to: 1) validate the diagnosis, 2) better quantify SRBD, and 3) calculate the sensitivity and specificity of the home study. Fourth, in year 05, the applicants will test, cross-sectionally, specific hypotheses related to: 1) SRBD and asymptomatic carotid artery atherosclerosis; 2) SRBD and blood pressure; 3) SRBD and the use of hormone-replacement therapy; 4) SRBD and cognitive function; 5) habitual snoring and asymptomatic carotid atherosclerosis; 6) habitual snoring and prevalent cardiovascular disease. The fifth and long-term aim is to test, with adequate follow-up, whether SRBD is associated with atherosclerosis progression and with subsequent risk of cardiovascular disease. The proposed project has the advantages of 1) a multidisciplinary team of experienced cardiovascular epidemiologists, sleep researchers, and biostatisticians, and 2) an already established population-based cohort with high response rate and detailed measurements of cardiovascular risk factors, early atherosclerosis, and cardiovascular disease endpoints. It will, therefore, be an important and cost-efficient contribution to the multi-center Sleep Study.