CARDIOVASCULAR CONSEQUENCES OF SLEEP APNEA

积累的数据表明，睡眠呼吸暂停和较温和的睡眠形式- 与呼吸相关的疾病(SRBD)可能在 心血管疾病。然而，证据远远不是决定性的， 主要依靠SRBD替代措施和病例对照设计。这个 该项目的总体目标是前瞻性地调查 心血管疾病中的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， 动脉粥样硬化与心血管疾病的人群队列研究 在疾病方面，申请者招募并检查了4009名男性和女性 来自明尼阿波利斯郊区1987-1989年间。参与者接受了第二次 1990-1992年的考试，目前正在进行第三次考试 (1993-1995)。已为1996-1998年的第四次考试提供了资金。范围广泛的 生活方式、生化、生理和临床特征 包括颈动脉内膜中层厚度，a 衡量早期动脉粥样硬化的指标。队列被跟踪的是 动脉粥样硬化进展与心血管终点。所有这些都是 ARIC明尼阿波利斯的特点使其适合于多中心 睡眠研究。 这个项目有五个具体目标。首先，申请者将 通过邮寄问卷的方式，对3828名2级考试归国人员进行筛查，以确定 与SRBD相关的特征，如习惯性鼾声、观察到的呼吸暂停、 白天昏昏欲睡。第二，1000个同意的个人的子集- 500名男性和500名女性-没有临床心血管疾病-将 招募参加家庭通宵睡眠研究以获得呼吸暂停-低呼吸暂停 得分。为了增加研究的统计力量，样本将是 通过过度抽样习惯性打鼾者，增加了患有SRBD的个体。 第三，共有250名参与者(估计有200名检测呈阳性) SRBD和50项测试阴性)将在睡眠中接受多导睡眠监测 实验室：1)验证诊断，2)更好地量化SRBD，3) 计算家庭研究的灵敏度和特异度。第四，在 05年，申请者将对具体的假设进行横截面测试 与：1)SRBD和无症状颈动脉粥样硬化有关；2) SRBD与血压；3)SRBD与激素替代治疗 治疗；4)SRBD和认知功能；5)习惯性打鼾症和 无症状性颈动脉粥样硬化；6)习惯性打鼾症 心血管疾病。第五个也是长期的目标是测试， 充分的随访，SRBD是否与动脉粥样硬化相关 病情进展与随后的心血管疾病风险有关。 拟议的项目具有以下优势：1)拥有一个多学科团队 经验丰富的心血管流行病学家、睡眠研究人员和 生物统计学家，以及2)已经建立的基于人群的队列 具有高应答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，这将是一项具有成本效益的重要贡献 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.