Nocturnal Hypertension and Sleep

夜间高血压与睡眠

• 批准号: 9916802
• 负责人: Marwah Abdalla
• 金额: $ 19.35万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9916802
• 关键词: Adult; Affect; Ambulatory Blood Pressure Monitoring; Antihypertensive Agents; Area; Biometry; Blood Pressure; Cardiovascular Diseases; Clinic; Clinical Research; Clinical Trials; Communities; Control Groups; Cross-Sectional Studies; Data; Diastolic blood pressure; Education; Educational Intervention; Ensure; Event; Foundations; Frequencies; Future; Goals; Hour; Hypertension; Individual; Inpatients; Intervention; K-Series Research Career Programs; Link; Measurement; Methodology; Monitor; Morbidity - disease rate; Norepinephrine; Organ; Participant; Pharmaceutical Preparations; Phenotype; Photoplethysmography; Prevalence; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recording of previous events; Research; Research Methodology; Research Personnel; Research Training; Risk; Risk Factors; Sleep; Sleep disturbances; Standardization; Training; Wrist; actigraphy; awake; cardiovascular disorder risk; career; career development; deprivation; design; digital; effective intervention; experience; heart rate variability; improved; modifiable risk; mortality; multidisciplinary; novel; programs; research data dissemination; sleep health; sleep physiology; sleep quality; statistics; urinary

My overall career goal is to establish an independent program of research focusing on identifying novel interventions to decrease the morbidity and mortality associated with nocturnal hypertension (HTN), defined as having elevated blood pressure (BP) during sleep on 24-hour ambulatory BP monitoring (ABPM). Training plan: In the K23 Career Development Award application, I will obtain training in four areas in order to build an independent program of research with an expertise in HTN and sleep: Module 1: Research Methodology in HTN including Clinical Trials, Module 2: Clinical and Research Training in Sleep including Clinical Trials, Module 3: Quantitative Methodologies and Advanced Statistics in HTN, and Module 4: Research Dissemination and Transition to Independence. I have assembled a multidisciplinary team of senior investigators with expertise in HTN (Drs. Daichi Shimbo, Joseph Schwartz, and Paul Muntner), sleep research (Drs. Ari Shechter and Martica Hall), biostatistics (Dr. Schwartz), and randomized controlled trials (RCTs) (Drs. Schwartz and Shechter) who will meet regularly with me to ensure that I am progressing towards my research and training goals, and overall career development. Research plan: Individuals with higher sleep BP levels are at an increased risk of target organ damage and cardiovascular disease (CVD) events. Short sleep duration (SSD) defined as sleeping less than 7 hours per night, occurs in over 30% of adults, and is associated with an increased risk for CVD. Cross-sectional studies have shown that SSD is associated with elevated sleep BP levels which may be due to increased sympathetic activity and reduced parasympathetic activity. I will conduct a RCT to determine the effect of an 8-week sleep extension intervention on sleep BP as assessed on 24-hour ABPM among 66 individuals with SSD. Participants will be randomized to sleep extension (a validated sleep hygiene education intervention), aiming to increase sleep duration by up to 1 hour over 8 weeks as assessed by wrist actigraphy (n=33) vs. a control condition (education on sleep physiology; n=33). Participants will have 24-hour ABPM and standardized assessment of sympathetic and parasympathetic activity during 24- hour ABPM at baseline and 8 weeks later. I will determine whether sleep extension is associated with a reduction in mean sleep systolic BP, and secondarily, mean sleep diastolic BP (Primary Aim). I will examine whether sleep extension is associated with a reduction in sympathetic activity and an increase in parasympathetic activity from baseline to 8 weeks (Secondary Aim 1). The degree to which a reduction in mean sleep systolic BP with the sleep extension intervention is explained by a reduction in sympathetic and parasympathetic activity will also be examined (Secondary Aim 2). The analyses for the Primary Aim will also be stratified by nocturnal HTN and poor sleep quality status at baseline (Exploratory Aim). This study will provide a strong foundation for my planned career in HTN and sleep, and a future R01 proposal examining whether sleep extension reduces the increased CVD risk associated with higher sleep BP levels.

我的总体职业目标是建立一个独立的研究计划，重点关注识别新颖的 降低夜间高血压（HTN）相关发病率和死亡率的干预措施，定义为 24 小时动态血压监测 (ABPM) 表明睡眠期间血压 (BP) 升高。训练 计划：在K23职业发展奖申请中，我将获得四个方面的培训，以便建立 具有 HTN 和睡眠专业知识的独立研究计划：模块 1：研究方法 HTN，包括临床试验，模块 2：睡眠临床和研究培训，包括临床试验， 模块 3：HTN 中的定量方法和高级统计，模块 4：研究 传播和向独立的过渡。我组建了一支由资深人士组成的多学科团队 具有 HTN 专业知识的研究人员（Daichi Shimbo 博士、Joseph Schwartz 和 Paul Muntner）、睡眠研究 （Ari Shechter 博士和 Martica Hall 博士）、生物统计学（Schwartz 博士）和随机对照试验 (RCT)（Drs. Schwartz 和 Shechter）将定期与我会面，以确保我的研究取得进展 培训目标以及整体职业发展。研究计划：睡眠血压水平较高的个体 靶器官损伤和心血管疾病 (CVD) 事件的风险增加。睡眠时间短 持续时间 (SSD) 定义为每晚睡眠时间少于 7 小时，发生在超过 30% 的成年人中，并且与 CVD 风险增加。横断面研究表明 SSD 与睡眠质量提高有关 血压水平升高可能是由于交感神经活动增加和副交感神经活动减少所致。我会 进行一项随机对照试验，以确定 8 周睡眠延长干预对睡眠血压的影响，评估结果为 66 名 SSD 患者的 24 小时 ABPM。参与者将被随机分配睡眠延长（经过验证的 睡眠卫生教育干预），旨在在 8 周内将睡眠时间增加最多 1 小时 通过腕部活动记录仪（n=33）与对照条件（睡眠生理学教育；n=33）进行评估。参加者 将进行 24 小时 ABPM 以及 24 小时内交感神经和副交感神经活动的标准化评估 基线时和 8 周后的 1 小时 ABPM。我将确定睡眠延长是否与 降低平均睡眠收缩压，其次是平均睡眠舒张压（主要目标）。我会检查 睡眠延长是否与交感神经活动的减少和交感神经活动的增加有关 从基线到 8 周的副交感神经活动（次要目标 1）。减少的程度 睡眠延长干预后的平均睡眠收缩压可以通过交感神经和血压的降低来解释。 还将检查副交感神经活动（次要目标 2）。主要目标的分析也将 根据基线夜间高血压和睡眠质量状况不佳进行分层（探索性目标）。这项研究将 为我计划的 HTN 和睡眠职业生涯以及未来的 R01 提案审查提供坚实的基础 延长睡眠时间是否可以降低与较高睡眠血压水平相关的心血管疾病风险增加。