Sleep Apnea, PAP Therapy, and Kidney Function Trajectory

睡眠呼吸暂停、PAP 治疗和肾功能轨迹

• 批准号: 8765891
• 负责人: Muna T Canales
• 金额: $ 23.43万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8765891
• 关键词: Address; Adult; Affect; American; Apnea; Area; California; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Chronic Kidney Failure; Clinical; Cohort Studies; Communities; Comorbidity; Computerized Medical Record; Creatinine; Data Collection; Data Set; Databases; Detection; Devices; Diabetes Mellitus; Diagnosis; Dialysis procedure; Disease; Disease Progression; Effectiveness; Electronic Health Record; End stage renal failure; Endocrine; Endocrine system; Evaluation; Foundations; Funding; Future; Glomerular Filtration Rate; Gold; Health; Healthcare; Hypertension; Individual; Intervention; Intervention Studies; Kidney; Kidney Diseases; Kidney Transplantation; Lead; Measurement; Measures; Modeling; Morbidity - disease rate; Neuraxis; Outcome; Patients; Population; Population Heterogeneity; Population Research; Prevention; Prospective Studies; Renal function; Research; Risk; Risk Factors; Serum; Severities; Site; Sleep; Sleep Apnea Syndromes; Testing; Time; United States National Institutes of Health; Wisconsin; base; clinical practice; cohort; comparison group; cost; effectiveness trial; improved; meetings; middle age; modifiable risk; mortality; novel; pressure; prevent; prospective; public health relevance; screening; standard measure; therapy outcome; trend

DESCRIPTION (provided by applicant): The purpose of this study is to determine if sleep apnea is a novel, modifiable risk factor for chronic kidney disease (CKD). We propose a study of existing data sets to help determine if kidney function loss is accelerated in patients who are diagnosed with sleep apnea, and if positive airway pressure (PAP) therapy for sleep apnea reduces the rate of kidney function loss. We will accomplish these aims through longitudinal analyses using two rich and complementary data sets: the Wisconsin Sleep Cohort and Kaiser Permanente Southern California (KPSC) Population Research Databases. Sleep apnea is common disorder affecting 1 in 5 Americans and can be effectively treated using PAP therapy. Sleep apnea shares a similar risk profile to CKD, including hypertension and diabetes, the two most common causes of end-stage kidney disease (ESKD). Sleep apnea is known to be deleterious to the cardiovascular, central nervous and endocrine systems. The relationship of sleep apnea to CKD is not yet clear. We hypothesize that a faster rate of kidney function loss will be observed in individuals who are later diagnosed with apnea and in individuals with more severe sleep apnea. We hypothesize that PAP therapy will slow kidney function loss and that effective PAP therapy will slow kidney function loss to a greater degree than ineffective therapy. The Wisconsin Sleep Cohort Study (WSCS) is 20-year ongoing NIH-funded prospective study of 1,522 middle-aged healthy adults with periodic assessments of sleep apnea severity using gold-standard measures, measures of PAP therapy adequacy, and serial serum creatinine tests from which kidney function may be estimated. The KPSC Population Research Databases contain validated case-identification of over 100,000 sleep apnea patients, including diagnosis and PAP device dispensation dates, and complete electronic medical records that include clinically obtained serum creatinine tests. In both cohorts, kidney function will be assessed based on the estimated glomerular filtration rate (eGFR). We will model eGFR trajectory using linear slopes and non-linear mixed models to compare eGFR trend before and after PAP therapy. In each cohort, a non- apnea comparison group will be constructed and major comorbidities will be controlled. We intend this study to directly inform the conduct of a future effectiveness trial in which screening and therapy for sleep apnea is compared across intervention and non-intervention sites utilizing active and passive data collection in a large population, such as KPSC. The results of this study have the potential to push forward a promising area of research that eventually may alter the evaluation and treatment of patients at high renal risk or with established CKD to help prevent related morbidity and mortality.

描述（由申请人提供）：本研究的目的是确定睡眠呼吸暂停是否是慢性肾脏疾病（CKD）的一种新的、可改变的危险因素。我们建议对现有数据集进行研究，以帮助确定被诊断为睡眠呼吸暂停的患者是否会加速肾功能丧失，以及睡眠呼吸暂停的气道正压（PAP）治疗是否会降低肾功能丧失的发生率。我们将通过使用两个丰富且互补的数据集进行纵向分析来实现这些目标：威斯康辛睡眠队列和Kaiser Permanente Southern California （KPSC）人口研究数据库。睡眠呼吸暂停是一种常见的疾病，影响了五分之一的美国人，可以通过PAP疗法有效地治疗。睡眠呼吸暂停与CKD有相似的风险，包括高血压和糖尿病，这是终末期肾病（ESKD）的两种最常见原因。众所周知，睡眠呼吸暂停对心血管、中枢神经和内分泌系统有害。睡眠呼吸暂停与慢性肾病的关系尚不清楚。我们假设，在后来被诊断为呼吸暂停的个体和睡眠呼吸暂停更严重的个体中，肾功能丧失的速度会更快。我们假设PAP治疗可以减缓肾功能丧失，并且有效的PAP治疗比无效的PAP治疗更能减缓肾功能丧失。