Cognition After OSA Treatment Among Native American People

美洲原住民接受 OSA 治疗后的认知

• 批准号: 10459243
• 负责人: KA'IMI ALOHILANI SINCLAIR
• 金额: $ 41.32万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10459243
• 关键词: Adherence; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; American Indians; Amyloid beta-Protein; Amyloid deposition; Apnea; Arizona; Attention; Behavior Therapy; Behavioral; Biological Markers; Body Weight decreased; Breathing; Cardiovascular Diseases; Cerebrospinal Fluid; Cerebrovascular Disorders; Clinical Trials; Cognition; Cohort Studies; Communities; Complex; Data; Data Collection; Dementia; Diabetes Mellitus; Diagnosis; Diagnostic Equipment; Disease; Effectiveness of Interventions; Elderly; Epidemiology; Excessive Daytime Sleepiness; Executive Dysfunction; FDA approved; Family Study; Functional disorder; Gold; Healthcare; Heart; High Prevalence; Home; Hour; Hypertension; Impaired cognition; Individual; Intervention; Link; Long-Term Effects; Magnetic Resonance Imaging; Measures; Mediating; Meta-Analysis; Minority Groups; Native Americans; Neurologic; Obesity; Observational epidemiology; Obstruction; Obstructive Sleep Apnea; Oklahoma; Outcome; Participant; Patients; Persons; Polysomnography; Population; Population Study; Positron-Emission Tomography; Prevalence; Prevention program; Protocols documentation; Qualitative Methods; Randomized; Randomized Controlled Trials; Reporting; Research; Research Project Grants; Reservations; Risk; Risk Factors; Site; Sleep; Sleep Apnea Syndromes; Sleep Disorders; South Dakota; Symptoms; Testing; Time; Vascular Diseases; base; behavior test; brain morphology; cognitive change; cognitive development; cognitive function; cohort; dementia risk; effectiveness evaluation; evidence base; executive function; experience; frontier; improved; low socioeconomic status; member; mild cognitive impairment; motivational enhancement therapy; northern plains; novel; population based; positive airway pressure; pragmatic trial; pressure; primary outcome; recruit; sleep position; sleep quality; standard care; treatment adherence; treatment as usual; vascular risk factor

RESEARCH PROJECT 3: ABSTRACT Prevalence of obstructive sleep apnea (OSA) among older adults in the US is as high as 56%. Short-term neurological consequences of OSA include cognitive changes such as poor attention and impaired executive function, although the mechanisms for these associations are unclear. OSA also increases risk of Alzheimer’s disease and related dementias (ADRD) and mild cognitive impairment, as well as alters ADRD biomarkers. Positive airway pressure is the gold standard treatment for OSA and improves cognition in clinical trials, including patients with ADRD. Although American Indians have a high prevalence of obesity, a risk factor for both OSA and ADRD, no reliable population-based estimates of OSA prevalence exist for AIs. OSA also is likely underdiagnosed in American Indians, and data strongly suggest a disparity in this modifiable ADRD risk factor. Accordingly, we will generate population-based estimates of OSA prevalence and its association with cognitive function, develop a novel intervention, and conduct a randomized pragmatic trial. For the epidemiology component, we will recruit members of 2 studies affiliated with the Strong Heart Study, the only population-based study of cardiovascular and cerebrovascular disease in American Indians. We will screen 450 cohort members ages 55+ living on 2 Northern Plains reservations for OSA and measure cognitive function. Participants with suspected OSA will undergo testing with the WATCHPAT, an FDA-approved sleep apnea diagnostic device. Participants whose results confirm OSA will be referred for positive airway pressure therapy and be eligible for the trial. Analyses will leverage previously collected data to identify fixed and time- varying risk factors for OSA. Next, we will develop the behavioral intervention by using qualitative methods to revise existing protocols for motivational interviewing and electronic messaging to increase pressure treatment adherence. For the randomized controlled trial, we will recruit 300 American Indians ages 55+ from the same Strong Heart Study communities who receive positive airway pressure treatment for OSA. They will be randomized to receive usual care, or usual care plus the intervention. Data collection at baseline, 3 months and 12 months will include positive airway pressure adherence, sleep quality, cognitive function, and vascular risk factors for ADRD. Primary outcomes are positive airway pressure adherence and cognitive function, with the former evaluated as a mechanistic explanation for change in the latter. Our Specific Aims are to: 1) Estimate the prevalence of OSA and its association with cognitive function in older American Indians, and identify OSA risk factors from existing longitudinal data collected by the 2 Strong Heart-Study-affiliated studies; 2) Develop the behavioral intervention and test its effect on positive airway pressure adherence and sleep quality; and 3) Assess the intervention’s effectiveness on cognitive function and ADRD vascular risk factors. This unique study explores the relationship between OSA and cognitive function in an understudied, at-risk, frontier population with limited access to specialized healthcare. It also takes an important step toward evaluating OSA as a mechanism for the strong association between OSA and ADRD.

研究项目 3：摘要 美国老年人中阻塞性睡眠呼吸暂停 (OSA) 的患病率高达 56%。短期 OSA 的神经系统后果包括认知改变，例如注意力不集中和执行力受损 功能，尽管这些关联的机制尚不清楚。 OSA 还会增加患阿尔茨海默病的风险 疾病及相关痴呆 (ADRD) 和轻度认知障碍，以及改变 ADRD 生物标志物。 气道正压通气是治疗 OSA 的金标准，可改善临床试验中的认知能力， 包括 ADRD 患者。尽管美洲印第安人肥胖率很高，但肥胖是肥胖的一个危险因素 对于 OSA 和 ADRD，对于 AI 而言，不存在可靠的基于人群的 OSA 患病率估计。 OSA 也是 美洲印第安人可能没有得到充分诊断，数据强烈表明这种可改变的 ADRD 风险存在差异 因素。因此，我们将对 OSA 患病率及其与 认知功能，开发新的干预措施，并进行随机实用试验。对于 流行病学部分，我们将招募隶属于“强心脏研究”的 2 个研究的成员，这是唯一一个 美洲印第安人心脑血管疾病的人群研究。我们会筛选 居住在 2 个北部平原 OSA 保留地的 450 名年龄 55 岁以上的队列成员测量认知能力 功能。疑似患有 OSA 的参与者将接受 WATCHPAT 测试，WATCHPAT 是 FDA 批准的睡眠产品 呼吸暂停诊断装置。结果确认 OSA 的参与者将被转介接受气道正压通气治疗 治疗并有资格参加试验。分析将利用之前收集的数据来识别固定的和时间变化的数据。 OSA 的不同危险因素。接下来，我们将通过使用定性方法来开展行为干预 修改现有的动机访谈和电子消息协议以增加压力治疗 坚持。对于随机对照试验，我们将从以下地区招募 300 名 55 岁以上的美国印第安人： 接受气道正压通气治疗 OSA 的强心脏研究社区也是如此。他们将是 随机接受常规护理或常规护理加干预。基线数据收集，3 个月 12 个月将包括气道正压依从性、睡眠质量、认知功能和血管 ADRD 的危险因素。主要结局是气道正压通气依从性和认知功能， 前者被评价为后者变化的机械解释。我们的具体目标是：1) 估计美国老年印第安人中 OSA 的患病率及其与认知功能的关系，以及 从 2 项 Strong Heart-Study 附属研究收集的现有纵向数据中确定 OSA 危险因素； 2) 制定行为干预措施并测试其对气道正压依从性和睡眠的影响 质量; 3) 评估干预措施对认知功能和 ADRD 血管危险因素的有效性。 这项独特的研究探讨了 OSA 与认知功能之间的关系，该研究尚未得到充分研究，存在风险， 边境人口获得专业医疗服务的机会有限。也迈出了重要的一步 评估 OSA 作为 OSA 与 ADRD 之间强关联的机制。