Impact of Sleep Apnea in Elderly Veterans with Comorbid COPD

睡眠呼吸暂停对患有慢性阻塞性肺病的老年退伍军人的影响

• 批准号: 9143237
• 负责人: Susmita Chowdhuri
• 金额: --
• 依托单位: JOHN D DINGELL VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9143237
• 关键词: Aging; Alzheimer' s Disease; Animals; Area; Arousal; Attention; Brain; Brain Injuries; Chronic; Chronic Obstructive Airway Disease; Chronic lung disease; Clinic; Clinical; Clinical Trials; Cognitive deficits; Continuous Positive Airway Pressure; Data; Dementia; Detection; Disease; Early Diagnosis; Elderly; Ensure; Etiology; Functional disorder; Future; Goals; Health; Health system; High Prevalence; Hypoxia; Impaired cognition; Inflammation; Injury; Investigation; Lead; Link; Mediating; Mental Depression; Multiple Sclerosis; Neurocognition; Neurocognitive; Neurocognitive Deficit; Neurodegenerative Disorders; Obstructive Sleep Apnea; Outcome; Oxygen; Oxygen Therapy Care; Parkinson Disease; Patients; Pilot Projects; Policies; Population; Prevalence; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Recovery; Rehabilitation therapy; Research; Risk; Risk Factors; Sample Size; Severities; Sleep Apnea Syndromes; Stroke; Syndrome; Therapeutic Intervention; Veterans; base; clinical care; cognitive function; cognitive testing; disability; high risk; improved; improved outcome; innovation; mortality; neurocognitive disorder; neurocognitive test; novel; novel therapeutics; older patient; patient oriented; personalized therapeutic; pressure; public health relevance; repaired; treatment strategy

 DESCRIPTION (provided by applicant): Cognitive dysfunction in the aging Veteran population is a growing health concern in the Veterans Health System. While neurodegenerative disorders, like Alzheimer's disease, Parkinson's disease and Multiple Sclerosis have received considerable attention as potential etiologies for dementia, obstructive sleep apnea (OSA), that also produces significant neurocognitive sequelae remains unrecognized as a cause. This is surprising given that the prevalence of sleep apnea in elderly Veterans has been estimated to be up to 40%. Moreover, chronic lung disease, particularly COPD, is now also thought to contribute to cognitive decline possibly through hypoxic injury to the brain. However, it is not known whether OSA coexisting with COPD will enhance the risk for cognitive dysfunction. Thus, we sought to investigate whether these two highly prevalent diseases, that often co-exist as the 'Overlap Syndrome', combine to enhance cognitive impairment in the elderly Veteran population. Additionally, treatment of OSA with positive airway pressure (PAP) has been shown to improve neurocognitive function in moderate-to-severe OSA while cognitive decline in COPD may be reversible through treatment with long-term oxygen therapy. Thus, it is conceivable that developing treatment strategies that target the pathophysiological underpinnings of the Overlap Syndrome, aimed at repairing hypoxia and arousal-induced 'brain injury', will allow recovery of neurocognitive function. Specific Aim 1 will investigate whether elderly Veterans with the Overlap Syndrome have increased neurocognitive deficits compared with OSA or COPD alone. Specific Aim 2 will further study the Overlap Syndrome group to determine whether treatment with CPAP and supplemental oxygen vs. CPAP alone will improve neurocognitive function and reduce sleepiness in conjunction with improved quality of life. Thus, using a novel dual-pronged strategy we hope to eventually delay the onset of dementia in a high-risk Veteran population. This pilot project will allow us to determine feasibility and sample size for a future larger long-term trial. Ultimately, our goal is to enhance rehabilitation and recovery from injury caused by two chronic conditions and thus, improve the overall health and quality of life of elderly Veterans.

 描述（由申请人提供）： 老年退伍军人群体的认知功能障碍是退伍军人卫生系统中日益严重的健康问题。虽然神经退行性疾病，如阿尔茨海默病、帕金森病和多发性硬化症作为痴呆的潜在病因受到了相当大的关注，但也产生显著神经认知后遗症的阻塞性睡眠呼吸暂停（OSA）仍然未被认识为原因。这是令人惊讶的，因为老年退伍军人睡眠呼吸暂停的患病率估计高达40%。此外，慢性肺部疾病，特别是COPD，现在也被认为可能通过对大脑的缺氧损伤导致认知能力下降。然而，目前尚不清楚OSA与COPD共存是否会增加认知功能障碍的风险。因此，我们试图调查这两种高度流行的疾病，通常共存的“重叠综合征”，联合收割机，以加强老年退伍军人群体的认知障碍。此外，使用气道正压通气（PAP）治疗OSA已被证明可改善中重度OSA的神经认知功能，而COPD的认知功能下降可通过长期氧疗治疗逆转。因此，可以想象，开发针对重叠综合征的病理生理学基础的治疗策略，旨在修复缺氧和觉醒诱导的“脑损伤”，将允许神经认知功能的恢复。具体目标1将研究与单独的OSA或COPD相比，患有重叠综合征的老年退伍军人是否具有增加的神经认知缺陷。具体目标2将进一步研究重叠综合征组，以确定CPAP和辅助供氧治疗与单独CPAP治疗相比是否会改善神经认知功能，减少嗜睡，同时改善生活质量。因此，使用一种新的双管齐下的策略，我们希望最终延迟高风险退伍军人人群中痴呆症的发作。该试点项目将使我们能够确定未来更大规模长期试验的可行性和样本量。最终，我们的目标是加强两种慢性疾病造成的伤害的康复和恢复，从而改善老年退伍军人的整体健康和生活质量。