Sleep Disorders and Risk of ESRD, Death and Poor QOL in Veterans with CKD

描述（由申请人提供）： 背景资料：慢性肾脏疾病（CKD）影响多达五分之一的退伍军人，并与心血管疾病，死亡和生活质量（QOL）差独立相关。睡眠呼吸障碍（SDB）在退伍军人中也很常见，会增加心血管疾病、死亡和生活质量差的风险。虽然与一般人群相比，SDB在晚期CKD患者中的患病率很高，但迄今为止，还没有研究检查SDB对晚期CKD健康结局的影响。方法：我们将在北佛罗里达/南格鲁吉亚退伍军人卫生系统对患有晚期CKD的退伍军人进行首次前瞻性队列研究。将邀请2011年4月1日至2012年3月31日期间患有晚期CKD的退伍军人进行基线便携式睡眠研究、问卷调查和肾功能测量。退伍军人将被随访3年，以确定CKD进展和生活质量下降的风险。我们还将验证标准SDB风险评估问卷，用于晚期CKD退伍军人。重要性：拟议的研究将通过潜在地确定进展为ESRD和QOL差的新风险因素，极大地影响患有晚期CKD的退伍军人的健康结果。此外，这项研究将是第一个在晚期CKD中验证简单易用的SDB风险评估工具的研究。这项工作将导致未来的建议，将1）确定SDB是否促进CKD进展和早期至中度CKD退伍军人的生活质量差; 2）制定和实施CKD患者SDB筛查指南，纳入简单易用的SDB风险评估工具; 3）确定在地方和国家VA水平实施这些指南对CKD进展和生活质量的影响。因此，拟议工作的结果将为研究奠定基础，以改善CKD和SDB退伍军人的CKD相关结果。 公共卫生相关性： 慢性肾脏病（CKD）在退伍军人中很常见，会增加心脏病、死亡和生活质量差的风险。睡眠呼吸障碍（SDB）是一种在退伍军人和晚期CKD中也很常见的疾病，可能导致终末期肾病，增加死亡风险和生活质量差。 本申请中提出的研究将确定SDB是否会增加晚期CKD退伍军人终末期肾病和生活质量差的风险。此外，研究者将确定标准SDB风险评估问卷在晚期CKD中是否有效。这项研究的结果将为将来制定筛查退伍军人CKD SDB的指南提供信息，并证明这种干预对地方和国家VA水平的CKD进展和QOL的影响。

DESCRIPTION (provided by applicant): Background: Chronic kidney disease (CKD) affects up to 1 in 5 veterans and is independently associated in a graded fashion with cardiovascular disease, death and poor quality of life (QOL). Sleep-disordered breathing (SDB) is also common among veterans and increases risk of cardiovascular disease, death and poor QOL. While SDB is highly prevalent among those with advanced CKD compared to the general population, to date no study has examined the effect of SDB on health outcomes in advanced CKD. Methods: We will perform the first prospective cohort study of veterans with advanced CKD in the North Florida/South Georgia Veterans Health System. Veterans between 4/1/2011 and 3/31/2012with advanced CKD will be invited to undergo baseline portable sleep study, questionnaires, and renal function measure. Veterans will be followed for 3 years to determine risk of CKD progression and reduced quality of life. We will also validate a standard SDB risk-assessment questionnaire for use among veterans with advanced CKD. Significance: The proposed research will greatly impact health outcomes for veterans with advanced CKD by potentially identifying a novel risk factor for progression to ESRD and poor QOL. In addition, this research will be the first to validate a simple to-use SDB-risk assessment tool in advanced CKD. This work will lead to future proposals that will 1) determine if SDB promotes progression of CKD and poor QOL in veterans with early to moderate CKD; 2) develop and implement guidelines for SDB screening of CKD patients, incorporating a simple to use SDB risk- assessment tool; and 3) determine the impact of implementing these guidelines on CKD progression and QOL at the local and national VA levels. As such, results of the proposed work will lay the foundation for research that stands to improve CKD-related outcomes for veterans with CKD and SDB. PUBLIC HEALTH RELEVANCE: Chronic kidney disease (CKD) is common among veterans and increases risk of heart disease, death and poor quality of life. Sleep-disordered breathing (SDB), a disorder that is also common in veterans and advanced CKD, may lead to end-stage renal disease and increase risk of death and poor quality of life. The research proposed in this application will determine whether SDB increases risk of end-stage renal disease and poor quality of life among veterans with advanced CKD. In addition, the investigators will determine whether a standard SDB risk-assessment questionnaire is valid in advanced CKD. Results of this study will inform future proposals to develop guidelines for screening of veterans with CKD for SDB and demonstrate the impact of this intervention on CKD progression and QOL at local and national VA levels.