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

描述（由申请人提供）：尽管国家采取措施解决健康差距问题，非洲裔美国人（AAs）患心血管疾病（CVD）的比率高于欧洲裔美国人（EAs）。杰克逊心脏研究（JHS）成立于2000年，其目的是产生数据，以支持减少心血管疾病差异的公共卫生建议。这项具有里程碑意义的研究报道，与美国其他以EA为主的队列相比，全AA队列中糖尿病和未控制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，这表明其他未测量的因素在影响不良的心脏代谢结果方面可能起着潜在的作用。虽然JHS已经全面评估了各种各样的心血管疾病危险因素，但一个显著的差距是缺乏对睡眠呼吸障碍（SDB）和睡眠模式的客观评估。最近主要来自EA样本的研究表明，SDB和睡眠不足都与冠心病、糖尿病和中风的发病率增加有关，从而强调了纠正这一差距的重要性。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危险因素来改善心血管疾病的差异。这项拟议的研究将在1200名JHS队列成员中检查SDB、睡眠不足、肥胖、心理社会文化变量和心血管疾病危险因素之间的关系。使用低负担但可靠的家庭睡眠呼吸暂停监测和手腕活动记录仪客观评估睡眠呼吸暂停和睡眠模式。为了评估心血管疾病的中间测量，特别是与中风和糖尿病相关的，内膜中膜厚度（IMT），血压，以及血糖控制和炎症的生化指标将使用严格的方案获得。这些数据将用于实现三个具体目标：(1)确定AAs中SDB和睡眠不足的危险因素，包括与少数民族人群相关的主要和次要压力和负面情绪的新测量；(2)阐明SDB严重程度、睡眠不足与未控制的高血压、脑卒中和糖尿病风险的关系；(3)量化SDB在统计上介导肥胖与传统心血管疾病危险因素之间关系的程度。我们的研究将确定睡眠障碍作为AAs中CVD的新的可改变危险因素的作用，为更好地筛查SDB提供基础，并加强对睡眠障碍如何影响卒中和糖尿病、高血压和血脂异常等中间CVD结局的科学理解。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CVD事件、发病率和死亡率联系起来。

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.