Novel physiologiC prEdictors of Positive Airway Pressure effectiveness: NICE-PAP study.

气道正压有效性的新型生理预测因素：NICE-PAP 研究。

• 批准号: 10685994
• 负责人: ANDREY ZINCHUK
• 金额: $ 17.23万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10685994
• 关键词: Accounting; Acetazolamide; Address; Adherence; Adult; Affect; Age; American; Anatomy; Apnea; Arousal; Atrial Fibrillation; Automobile Driving; Biological; Biometry; Breathing; Catheters; Clinical Pathways; Clinical Research; Clinical Trials Design; Compensation; Complement; Continuous Positive Airway Pressure; Critical Care; Data; Data Set; Development Plans; Diabetes Mellitus; Diagnosis; Drowsiness; Effectiveness; Engineering; Environment; Epidemiology; Equipment; Exhibits; Expectancy; Future; Goals; Growth; Heart failure; Hour; Hypertension; Impairment; Individual; Infrastructure; Institution; Internal Medicine; Knowledge; Laboratories; Link; Lung; Measurement; Measures; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Methodology; Modification; Morbidity - disease rate; Myocardial Infarction; Obstructive Sleep Apnea; Outcome; Oxygen; Pathogenesis; Patient Care; Patient-Focused Outcomes; Patients; Pharyngeal structure; Physicians; Physiological; Physiology; Polysomnography; Predisposition; Prospective cohort; Psychological Factors; Psychosocial Factor; Pulmonology; Quality of life; Research; Research Methodology; Research Personnel; Research Project Grants; Research Training; Residual state; Resources; Risk; Role; Science; Scientist; Self Efficacy; Sleep; Sleep Apnea Syndromes; Sleeplessness; Social support; Stroke; Symptoms; Techniques; Training; Training Activity; Training Programs; Translating; Work; career development; clinical application; clinical epidemiology; cohort; common treatment; design; epidemiology study; experience; externship; hypnotic; improved; ineffective therapies; mortality; novel; novel strategies; patient oriented; patient oriented research; personalized care; personalized medicine; pharynx muscle; poor sleep; positive airway pressure; pressure; prevent; programs; prospective; psychologic; randomized trial; randomized, clinical trials; remote monitoring; response; sex; skills; sleep position; sleep quality; social; social factors; success; symptomatic improvement; tool; trait; treatment adherence; vehicular accident

Candidate. My goal is to become an independent physician-scientist who merges physiology and patient-ori- ented research methods to personalize care for patients with obstructive sleep apnea (OSA). My training as an engineer and a doctor in Pulmonary, Critical Care and Sleep Medicine (PCCSM), complemented by research training in epidemiology, have given me the background necessary to pursue this goal. I propose training activ- ities that will allow me to personalize treatments for one of the most pressing problems for OSA patients- effec- tiveness of continuous positive airway pressure (CPAP). Through coursework, externships and mentored expe- rience in physiologic and patient-oriented research, this training program will build skills and knowledge in 1) physiologic characterization of OSA, 2) treatment adherence, efficacy and patient-oriented outcomes, 3) conduct of clinical studies, 4) advanced biostatistics and 5) leading a research program. Executing this program will bridge current knowledge gaps related to the role of physiologic traits in CPAP effectiveness and set me up for success as an independent investigator. Mentors and Environment. I have engaged an exceptional team of mentors with expertise tailored for this proposal. My primary mentor, Dr. Yaggi, is a national expert in OSA epidemiology and clinical study conduct. My co-mentors are Dr. Wellman, a pioneer in translational OSA physiology, and Dr. Redeker, a leader in patient- centered outcomes sleep research. This proposal leverages a wealth of resources across institutions, including Yale’s Center for Precision Pulmonary Medicine and Clinical Epidemiology Research Center, Centers for Sleep Medicine, PCCSM Section and Internal Medicine Department. The Sleep Disordered Breathing laboratory led by Dr. Wellman at Harvard is a renowned OSA physiology center. This environment provides methodologic expertise, research tools and a venue to conduct cutting-edge patient-oriented research in sleep. Mentored Research Project. Most patients with OSA who are prescribed the gold-standard therapy, CPAP, are ineffectively treated. This is due to 1) poor CPAP adherence, 2) high residual apnea in 20% of users (low efficacy) and 3) inconsistent symptom improvement. To improve CPAP effectiveness, we propose to address novel phys- iologic targets that cause OSA in each individual: arousability, ventilatory control sensitivity and pharyngeal mus- cle compensation. Our overall objective is to determine the contribution of these traits to CPAP effectiveness independently of established biological, psychological and social predictors. This work leverages state-of-the art sleep study analysis tools and validated measures of the determinants of CPAP effectiveness to create a prag- matic, prospective cohort (n=267) of OSA patients. This unique dataset will help determine whether physiologic causes of OSA influence CPAP adherence, efficacy, sleep quality, symptoms, function and quality of life. The results will inform design and conduct of a randomized clinical trial designed to modify physiologic traits such as easy arousability to improve CPAP effectiveness and other patient-centered outcomes in OSA patients.

候选人。我的目标是成为一名独立的内科科学家，将生理学和病人学结合在一起。 探讨阻塞性睡眠呼吸暂停(OSA)患者个性化护理的研究方法。我作为一名 肺、重症监护和睡眠医学(PCCSM)工程师和医生，辅之以研究 流行病学方面的培训，给了我追求这一目标所需的背景知识。我建议积极开展培训- 这将使我能够对阻塞性睡眠呼吸暂停综合征患者最紧迫的问题之一进行个性化治疗-有效- 持续气道正压通气(CPAP)的效果。通过课程作业、外部奖学金和指导费用- 在生理学和以患者为中心的研究方面，该培训计划将在1)中培养技能和知识 阻塞性睡眠呼吸暂停的生理学特征，2)治疗依从性、疗效和以患者为导向的结果，3)行为 临床研究，4)先进的生物统计学，5)领导研究计划。执行此程序将 弥合目前与生理特征在CPAP有效性中的作用相关的知识差距，并为我 作为一名成功的独立调查员。 导师和环境。我已经聘请了一支出色的导师团队，他们的专业知识就是为此量身定做的 求婚。我的主要导师Yaggi博士是阻塞性睡眠呼吸暂停综合征流行病学和临床研究方面的国家专家。我的 共同导师是翻译OSA生理学的先驱Wellman博士和Patient-OSA生理学的领导者Redeker博士。 以结果为中心的睡眠研究。这项提议利用了各机构的大量资源，包括 耶鲁大学精确肺部医学中心和临床流行病学研究中心，睡眠中心 内科、中医组和内科。睡眠障碍呼吸实验室 哈佛大学的Wellman博士是OSA著名的生理学中心。这种环境提供了方法论 专业知识、研究工具和开展以患者为中心的前沿睡眠研究的场所。 指导研究项目。大多数OSA患者在接受黄金标准疗法CPAP治疗后， 治疗不力。这是由于1)CPAP依从性差，2)20%的使用者呼吸暂停残留率高(疗效低) (3)症状改善不一致。为了提高CPAP的有效性，我们建议解决新的PHYS- 导致每个个体OSA的生物学指标：唤醒能力、呼吸控制敏感性和咽部肌肉- 克雷格补偿。我们的总体目标是确定这些特征对CPAP有效性的贡献 独立于既定的生物、心理和社会预测因素。这部作品充分利用了最先进的技术 睡眠研究分析工具和CPAP有效性决定因素的验证措施，以创建PRAG- 马季奇，阻塞性睡眠呼吸暂停患者前瞻性队列(n=267)。这一独特的数据集将有助于确定生理学 阻塞性睡眠呼吸暂停的原因影响CPAP的依从性、疗效、睡眠质量、症状、功能和生活质量。这个 结果将为设计和实施一项随机临床试验提供依据，该试验旨在改变生理特征，如 易于唤醒以改善CPAP效果和其他以患者为中心的OSA患者结局。

项目成果

Sleep Deficiency in Obstructive Sleep Apnea.

• DOI: 10.1016/j.ccm.2022.02.013
• 发表时间: 2022-06
• 期刊: CLINICS IN CHEST MEDICINE
• 影响因子: 5.7
• 作者: Adekolu, Olurotimi;Zinchuk, Andrey
• 通讯作者: Zinchuk, Andrey

Periodic limb movements during sleep and risk of hypertension: A systematic review.

• DOI: 10.1016/j.sleep.2023.01.008
• 发表时间: 2023-02
• 期刊: SLEEP MEDICINE
• 影响因子: 4.8
• 作者: Srivali, Narat;Thongprayoon, Charat;Tangpanithandee, Supawit;Krisanapan, Pajaree;Mao, Michael A.;Zinchuk, Andrey;Koo, Brain B.;Cheungpasitporn, Wisit
• 通讯作者: Cheungpasitporn, Wisit

Nicotine, alcohol, and caffeine use among individuals with untreated obstructive sleep apnea.

未经治疗的阻塞性睡眠呼吸暂停患者使用尼古丁、酒精和咖啡因的情况。

• DOI: 10.1007/s11325-023-02830-3
• 发表时间: 2023
• 期刊: Sleep & breathing = Schlaf & Atmung
• 作者: Baldassarri,StephenR;Chu,Jen-Hwa;Deng,Annan;Xu,Zhichao;Blohowiak,ReaganF;Byrne,Sean;Kushida,Clete;Yaggi,HKlar;Zinchuk,Andrey
• 通讯作者: Zinchuk,Andrey