Stress, Sleep and Emerging CVD Risk Factors

描述(由申请人提供)：越来越多的证据表明，心血管疾病(CVD)的发病率和死亡率不仅可以通过胆固醇水平、高血压、吸烟和高血糖等既定风险因素来预测，还可以通过一系列新出现的风险因素来预测。这些包括炎症标记物、C反应蛋白和白介素6、代谢综合征和轻度肾功能不全。由宾夕法尼亚联邦(Steven Reis，PI)资助的一个名为HeartSCORE的项目正在评估这些新出现的危险因素，以及1000名非裔美国人和1000名高加索人的人群样本中的冠状动脉钙化和臂动脉直径。我们提议的项目将在这一宝贵资源的基础上，通过研究另一组新的心血管疾病风险因素，这些因素被认为是更近的、新兴的风险因素的上游：睡眠呼吸紊乱(SDB)和心理社会压力。我们的项目将评估SDB和心理社会应激与心血管疾病风险的联系是否可能是由于它们对夜间生理的影响，即非SDB睡眠特征的改变，夜间血压相对于白天血压的升高(称为非浸泡)，尿儿茶酚胺和皮质醇升高，以及自主神经张力受损。因此，这项研究的总体目的是了解夜间心血管发病率和死亡率的心理生理学基础。为了达到这一总体目标，我们将从更大的HeartSCORE设计中的两组中抽取225名个体进行多种族样本研究：(1)那些具有高/中(以下标记为高)或(2)低Framingham风险方程评分的人，两组中的任何一组都没有中风、心肌梗死或介入性心脏病手术的病史。这两组人将在性别、种族和年龄方面匹配。这项拟议的研究将包括在参与者家中进行两个晚上的多导睡眠图(PSG)，两个24小时的动态血压(ABP)监测，第二个晚上和第二个ABP晚上的夜间尿液采集，10个晚上的手腕手术，以及自我报告和其他生理指标的评估。这项研究将提供新的数据，测试白天应激事件、SDB和其他夜间生理指标与心脏评分中新出现的危险因素和亚临床心血管疾病的关系。

DESCRIPTION (provided by applicant): Growing evidence suggests that cardiovascular disease (CVD) morbidity and mortality may be predicted not only by established risk factors such as cholesterol level, hypertension, cigarette smoking, and hyperglycemia, but also by a set of emerging risk factors. These include the inflammatory markers, C reactive protein and interleukin 6, metabolic syndrome, and mild renal insufficiency. A project called HeartSCORE funded by the Commonwealth of Pennsylvania (Steven Reis, PI) is evaluating these emerging risk factors as well as coronary calcification, and brachial artery diameter in a population-based sample of 1000 African Americans and 1000 Caucasians. Our proposed project will build on this invaluable resource by examining another set of novel risk factors for CVD thought to be upstream from the more proximal, emerging risk factors: sleep disordered breathing (SDB) and psychosocial stress. Our project will evaluate whether links of both SDB and psychosocial stress with CVD risk may be due to their effects on nocturnal physiology, namely altered nonSDB sleep characteristics, nighttime elevation in blood pressure relative to daytime BP (termed nondipping), elevated urinary catecholamines and cortisol, and impaired autonomic tone. Thus, the general aim of this study is to understand the nocturnal psychophysiological underpinnings of cardiovascular morbidity and mortality. To address this general aim, we will study a multi-ethnic sample of 225 individuals drawn from two of the groups in the larger HeartSCORE design: (1) those who have high/moderate (hereafter labeled high) or (2) low Framingham risk equation scores, with no history of stroke, myocardial infarction, or interventional cardiology procedures in either group. The two groups will be matched on gender, race, and age. The proposed study will include two nights of polysomnography (PSG) conducted in participants' homes, two 24-hour periods of ambulatory blood pressure (ABP) monitoring, overnight urine collections on PSG night 2 and ABP night 2, wrist actigraghy on 10 nights, and assessment of self-report and other physiological indices. The study will provide novel data testing the relationships of daytime stressful events, SDB, and other nocturnal physiological measures with the emerging risk factors and subclinical CVD measured in HeartSCORE.