CARDIOVASCULAR CONSEQUENCES OF SLEEP APNEA

严重的睡眠呼吸暂停（SA）是已知的与增加 发病率和死亡率。 有限的证据表明， 高度流行的疾病形式也可能与 心血管疾病和高血压的风险增加。 本 建议书是一个现场中心的申请， RFA-NIH-HL-94-09-L。 我们的主要目标是评估SA是否 与流行性和偶发性冠心病独立相关， 中风、高血压和亚临床动脉粥样硬化。 合作 与其他中心，我们也计划检查是否假设SA- 临床心血管疾病的相关风险被亚临床 动脉粥样硬化性疾病、高血压、年龄、性别和种族。 额外 目标包括调查的短期自然历史， 障碍，参与者的SA意识水平，SA对 生活质量以及对诊断和治疗的依从性 在那些与SA确定的建议。 我们还将估算成本 与SA相关的心血管发病率相关， 与人群中SA的诊断和治疗相关。 我们计划招募1,100名年龄在53岁以上的男女参与者， 从正在进行的NHLBI赞助的华盛顿县队列中选出 前瞻性社区动脉粥样硬化风险（ARIC）研究， 心血管健康研究（CHS）。 参与者将主要是白色， 反映了郡里的种族构成 关于风险因素的信息 自这些研究开始以来（1987年- 89）。 两个队列的可用B型超声数据为 颈动脉内膜+中膜厚度， 亚临床动脉粥样硬化，CHS参与者的超声心动图， 目前年龄在73岁或以上，ARIC的视网膜摄影 参与者，目前年龄在53-72岁之间。 两项母研究均符合 RFA要求数据应在五年内收集 睡眠研究的开始。 结果的确定是 标准化程度很高，随访率也很高。 对于研究人群的选择，将对受试者进行分层 根据他们的打鼾史 将进行家庭睡眠研究 对所有参与者进行多导睡眠图（PSG）， 异常结果和在被发现正常的个体的随机样本中 在家庭研究中。 后一个样本将用于验证结果 家庭研究。 睡眠检查将在两年内完成。 然后，我们将评估SA和相关疾病与 已查明的心血管疾病患病率、发病率和危险因素 通过ARIC和CHS中使用的临床检查和程序。 第二 PSG将在选定的参与者中进行，以比较SA病例， 控制，以解决研究的其他目标，包括 睡眠相关障碍对睡眠质量的影响 生活，以及SA的短期自然历史。

Severe forms of sleep apnea (SA) are known to be associated with increased morbidity and mortality. Limited evidence suggests that the milder, yet highly prevalent forms of the disorder may also be associated with increased risks of cardiovascular disease and hypertension. The present proposal is an application for one of the field centers in response to RFA-NIH-HL-94-09-L. Our main objective is to assess whether SA is independently related to prevalent and incident coronary heart disease, stroke, hypertension and subclinical atherosclerosis. In collaboration with the other centers, we also plan to examine whether the postulated SA- related risk of clinical cardiovascular disease is modified by subclinical atherosclerotic disease, hypertension, age, gender and race. Additional objectives include investigating the short-term natural history of the disorder, the level of SA awareness in participants, the impact of SA on quality of life, and compliance with diagnostic and treatment recommendations in those identified with SA. We will also estimate costs associated with both SA-related cardiovascular morbidity, and those related to diagnosis and treatment of SA in the population. We propose recruiting 1,100 participants of both sexes, ages 53 or older, selected from the Washington County cohorts of the ongoing NHLBI-sponsored prospective Atherosclerosis Risk in Communities (ARIC) Study and Cardiovascular Health Study (CHS). Participants will be mostly white, reflecting the racial composition of County. Information on risk factors has been collected repeatedly since the inception of these studies (1987- 89). Available for both cohorts are B-mode ultrasound data on intima+media thickness of the carotid arteries, an expression of subclinical atherosclerosis, echocardiography for CHS participants, currently aged 73 years or older, and retinal photography for ARIC participants, currently aged 53-72 years. Both parent studies meet the RFA's requirement that data should have been collected within five years of the initiation of the sleep studies. Ascertainment of outcomes is highly standardized, and follow-up rates are very high. For the selection of the study population, participants will be stratified according to their snoring history. A home sleep study will be conducted on all participants, followed by full polysomnography (PSG) in those with abnormal results and in a random sample of individuals found to be normal in the home study. The latter sample will be used to validate the results of the home study. The sleep examinations will be completed in two years. We will then assess the associations of SA and related disorders with cardiovascular disease prevalence, incidence and risk factors, ascertained through clinic examinations and procedures used in ARIC and CHS. A second PSG will be conducted in selected participants for comparing SA cases and controls, in order to address the other objectives of the study, including the evaluation of the impact of sleep related disorders on quality of life, and the short term natural history of SA.