Sleep-Disordered Breathing and Risk for CVD and Stroke in the Jackson Heart Study

描述(由申请人提供)：尽管国家采取了解决健康差距的举措，但非裔美国人(AA)的心血管疾病(CVD)，特别是中风的发病率高于欧洲裔美国人(EA)。杰克逊心脏研究(JHS)成立于2000年，目的是产生数据，以支持减少腹主动脉心血管疾病差距的公共卫生建议。这项里程碑式的研究报告称，与其他美国主要是EA的队列相比，这一完全由AA组成的队列中糖尿病和高血压的患病率更高。增加的危险因素患病率不能用肥胖或其他传统危险因素来解释，这表明额外的不可测量的因素在影响不利的心脏代谢结果方面可能起到作用。尽管JHS已经全面评估了各种心血管疾病风险因素，但一个显著的差距是缺乏对睡眠呼吸紊乱(SDB)和睡眠模式的客观评估。最近从以EA为主的样本中进行的研究突显了纠正这一差距的重要性，这些研究表明，SDB和睡眠不足分别与冠心病、糖尿病和中风的发病率增加有关。我们的初步数据还表明，SDB可能在完全AA的JHS队列中比在以白人为主的队列中更普遍。我们的长期目标是通过确定特定种族的可改变的风险因素来改善心血管疾病的差异。这项拟议的研究将在JHS队列的1200名成员中检查SDB、睡眠不足、肥胖、心理-社会-文化变量和心血管疾病风险因素之间的关系。睡眠呼吸暂停和睡眠模式将使用低负担但可靠的家庭睡眠呼吸暂停监测和手腕动作记录仪进行客观评估。为了评估心血管疾病的中期测量，特别是与中风和糖尿病有关的测量，将使用严格的方案获得内膜中层厚度(IMT)、血压以及血糖控制和炎症的生化指标。这些数据将被用来实现三个具体目标：(1)确定SDB和睡眠不足的风险因素，包括对与少数群体相关的主要和次要压力以及负面情绪的新测量；(2)阐明SDB严重程度、睡眠不足与失控高血压、中风和糖尿病风险之间的关系；以及(3)量化SDB可以在多大程度上从统计上调节肥胖和传统心血管疾病风险因素之间的关系。我们的研究将确定睡眠障碍作为AAS中CVD的新的可修改危险因素的作用，为促进更好地筛查SDB提供基础，并加强对睡眠障碍如何影响中风和中间心血管疾病结局(如糖尿病、高血压和血脂异常)的科学理解。最后，我们的研究结果将作为前瞻性分析的基础，将SDB与AAS的心血管事件、发病率和死亡率联系起来。 公共卫生相关性：这项拟议的研究将帮助我们更好地了解睡眠障碍和睡眠太少如何导致非裔美国人中风、糖尿病和心血管疾病的风险。这项研究收集的数据将帮助研究人员开发未来有针对性的健康干预措施，以减少心血管疾病的公共健康负担以及糖尿病、高血压和中风的种族差异。

DESCRIPTION (provided by applicant): Despite national initiatives to address health disparities, African Americans (AAs) suffer higher rates of cardiovascular disease (CVD), especially stroke, than European Americans (EAs). The Jackson Heart Study (JHS) was established in 2000 with the aim of generating data that would support public health recommendations for reducing CVD disparities in AAs. This landmark study has reported a higher prevalence of diabetes and uncontrolled hypertension in this entirely AA cohort compared to other U.S. mostly EA cohorts. Increased risk factor prevalence is not explained by obesity or other traditional risk factors, suggesting a potential role for additional unmeasured factors in influencing adverse cardio- metabolic outcomes. Although JHS has comprehensively assessed a wide variety of CVD risk factors, a notable gap has been the absences of objective assessment of sleep disordered breathing (SDB) and sleep patterns. The importance of rectifying this gap is underscored by recent research from predominantly EA samples that have demonstrated that SDB and insufficient sleep each are associated with increased incidence of coronary heart disease, diabetes, and stroke. Our preliminary data also indicate that SDB may be more prevalent in the entirely AA JHS cohort than in predominantly white cohorts. Our long-range goal is to ameliorate CVD disparities by identifying ethnicity-specific modifiable risk factors. The proposed study will examine relationships among SDB, insufficient sleep, obesity, psycho- socio-cultural variables, and CVD risk factors in 1,200 members of the JHS cohort. Sleep apnea and sleep patterns will be objectively assessed using low burden but reliable in-home sleep apnea monitoring and wrist actigraphy. To assess intermediate measurements of CVD, particularly related to stroke and diabetes, intimal media thickness (IMT), blood pressure, and biochemical indices of glucose control and inflammation will be obtained using rigorous protocols. These data will be used to achieve three specific aims: (1) Identify risk factors for SDB and insufficient sleep in AAs, including novel measurements of major and minor stress and negative emotions relevant to minority populations; (2) Elucidate relationships between SDB severity, insufficient sleep, and risk for uncontrolled hypertension, stroke and diabetes; and (3) Quantify the extent to which SDB may statistically mediate relationships between obesity and traditional CVD risk factors. Our study will identify the role of sleep disorders as novel modifiabe risk factors for CVD in AAs, provide a basis for promoting better screening for SDB, and enhance scientific understanding of how disparities in stroke and intermediate CVD outcomes such as diabetes, hypertension, and dyslipidemia are impacted by sleep disorders. Finally, the results of our study will serve as the foundation for prospective analyses linking SDB to incident CVD events, morbidity, and mortality in AAs. PUBLIC HEALTH RELEVANCE: The proposed study will help us better understand how sleep disorders and too little sleep contribute to the risk for stroke, diabetes, and cardiovascular disease in African Americans. The data gathered by this study will help researchers develop future targeted health interventions to reduce the public health burden of cardiovascular disease and racial disparities in diabetes, hypertension and stroke.