Sleep Heart Health Study (SHHS)

描述(申请人提供)：一般人群中，中年人睡眠呼吸障碍(SDB)的患病率估计为4%的男性和2%的女性，老年人的发病率较高。从回顾和横断面研究中积累的证据表明，SDB与心脑血管疾病(CVD)的存在相关，并由此导致死亡率和发病率的增加。然而，几乎没有前瞻性的数据表明SDB是否是CVD发生发展的一个独立的DSK因素。睡眠心脏健康研究(SHHS)是一项始于1994年的纵向多中心队列研究，目的是确定SDB对心血管的影响。最初，SHHS招募了6441名参与者(1996-98)接受家庭多导睡眠监测(PSG)，并获取其他心血管疾病和睡眠相关数据。另一次复查(2001-2003年)刚刚结束。死亡率和发病率跟踪正在进行中，但事件发生率不足以对SDB对心血管事件和死亡率的影响提供稳定的估计。此外，SHHS的一个独特资源是其约10,000个PSG、相关评分和临床协变量数据的档案。向科学界提供对这些数据的访问一直是卫生和公众服务部的一个重要目标，并有可能在从信号处理的新方法到确定独特的流行病学关联的合作研究中实现显著的好处。因此，这项申请建议对SHHS队列进行更多的死亡率和发病率跟踪，继续进行以SDB为心血管事件和高血压风险因素的纵向和横断面数据分析，并开发基础设施，以方便一般科学界查阅SHHS PSG档案。这些目标将通过实现以下具体目标来实现：1)继续对SHHS队列进行跟踪，以评估SDB作为突发高血压、突发和复发心血管事件的危险因素；2)描述SDB的自然病史，并确定RDI(呼吸暂停或低通气/每小时睡眠)的变化如何与临时和突发CVD事件的风险相关；3)表征SDB和SDB进展与生活质量和日间嗜睡指标的关系；4)使用PSG数据以及以前从父母队列中收集的风险因素数据，建立与SDB相关的临床和流行病学适用的风险模型；以及5)开发基础设施，以促进数据共享、协作分析以及向科学界传播数据分析工具和研究成果。实现这些目标将提供有关SDB对公共卫生影响的重要信息。

DESCRIPTION (provided by applicant): The prevalence of sleep disordered breathing (SDB) in middle aged persons in the general population is estimated to be 4 percent in men and 2 percent in women with higher rates observed in the elderly. Accumulating evidence from retrospective and cross-sectional studies suggest that SDB is associated with the presence of cardiovascular and cerebrovascular disease (CVD) and consequent increased mortality and morbidity. However, there is little prospective data indicating whether SDB is an independent dsk factor for the development of CVD. The Sleep Heart Health Study (SHHS) is a longitudinal multi-center cohort study that was started in 1994 to determine the cardiovascular consequences of SDB. Initially, SHHS recruited 6441 participants (1996-98) to undergo in-home polysomnography (PSG) and acquisition of other CVD and sleep-related data. Another examination with repeat PSG (2001-2003) has just been completed. Mortality and morbidity follow-up is ongoing, but event rates have been insufficient to provide stable estimates of the effect of SDB on incident CVD and mortality. Additionally, a unique resource of SHHS is its archive of approximately 10,000 PSGs, associated scoring and clinical covariate data. Providing the scientific community access to this data has always been an important goal of SHHS, and has the potential to realize significant benefits in collaborative research ranging from novel methods of signal processing to identifying unique epidemiologic associations. Therefore, this application proposes additional mortality and morbidity follow-up of the SHHS cohort, continuation of longitudinal and cross-sectional data analyses focused on SDB as a risk factor for cardiovascular events and hypertension, and development of an infrastructure to facilitate access by the general scientific community to the SHHS PSG archive. These goals will be achieved by accomplishing the following specific aims: 1) to continue follow-up of the SHHS cohort in order to assess SDB as a risk factor for incident hypertension, and incident and recurrent CVD events; 2) to characterize the natural history of SDB and determine how change in RDI (# apneas or hypopneas/hour of sleep) is related to risk for interim and incident CVD events; 3) to characterize the relationship between SDB and SDB progression with quality of life and indicators of daytime sleepiness; 4) to use the PSG data as well as previous collected risk factor data from parent cohorts to develop a clinically and epidemiologically applicable model of risk relating to SDB; and 5) to develop an infrastructure to facilitate data sharing, collaborative analysis, and dissemination of data analytic tools and research findings to the scientific community. Accomplishing these goals will provide important information concerning the public health impact of SDB.