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

描述(由申请人提供)： 背景：慢性肾脏疾病(CKD)影响多达五分之一的退伍军人，并以分级的方式独立地与心血管疾病、死亡和不良的生活质量(QOL)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、死亡和不良生活质量的风险。虽然与普通人群相比，SDB在晚期CKD患者中非常普遍，但到目前为止，还没有研究检查SDB对晚期CKD患者健康结局的影响。方法：我们将在北佛罗里达/南乔治亚退伍军人卫生系统对患有晚期慢性肾脏病的退伍军人进行第一次前瞻性队列研究。2011年4月1日至2012年3月31日之间患有晚期CKD的退伍军人将被邀请进行基线便携式睡眠研究、问卷调查和肾功能测量。退伍军人将被跟踪3年，以确定CKD进展和生活质量下降的风险。我们还将验证标准的SDB风险评估问卷，供患有晚期CKD的退伍军人使用。意义：这项拟议的研究将极大地影响患有晚期CKD的退伍军人的健康结局，因为它可能确定一个新的危险因素，导致进展到终末期肾病和较差的生活质量。此外，这项研究将首次验证一种简单易用的SDB风险评估工具在高级CKD中的有效性。这项工作将产生未来的建议，这些建议将：1)确定SDB是否促进早至中度CKD退伍军人的CKD进展和较差的生活质量；2)制定和实施CKD患者的SDB筛查指南，纳入一个简单易用的SDB风险评估工具；以及3)确定在地方和国家VA水平上实施这些指南对CKD进展和生活质量的影响。因此，拟议工作的结果将为改善患有CKD和SDB的退伍军人的CKD相关结果的研究奠定基础。 公共卫生相关性： 慢性肾脏疾病(CKD)在退伍军人中很常见，会增加心脏病、死亡和生活质量低下的风险。睡眠呼吸紊乱(SDB)是一种在退伍军人和晚期CKD中也很常见的疾病，可能会导致终末期肾脏疾病，增加死亡风险和生活质量。在这项申请中提出的研究将确定SDB是否会增加患有晚期CKD的退伍军人患终末期肾脏疾病和生活质量差的风险。此外，调查人员将确定标准的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未来制定CKD退伍军人SDB筛查指南的建议提供参考，并展示这种干预对地方和国家VA水平的CKD进展和生活质量的影响。

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.