The long-term effectiveness of and the disparities in access to treatments for obstructive sleep apnea: a study on the All of Us data

项目摘要 阻塞性睡眠呼吸暂停（OSA）是最常见的睡眠相关呼吸障碍， 高达38%的北美人。OSA导致低氧血症和氧化应激， 心血管疾病、2型糖尿病和各种慢性疾病的风险。它还 导致健康差异，因为种族和少数民族群体更有可能经历 延迟诊断和治疗比非西班牙裔白人，沿着的事实，这些 少数民族可能有更高的OSA患病率。OSA的治疗，包括持续的 气道正压通气（CPAP）和上气道手术可有效缓解患者的呼吸困难， 呼吸不足症状，因此也被认为可以降低这些发病率的风险。 然而，先前关于CPAP的研究并未显示出对这些结果的显著影响， 由于参与者的遵守情况不佳，调查结果仍然没有定论。此外，文学 关于上呼吸道手术的长期益处是非常缺乏的。也很重要 描述OSA患者的特征，这些患者将具有较高的长期发病风险。拟议 该项目将利用美国国立卫生研究院全民研究计划的大数据 研究CPAP和手术对下游发病率的长期影响，并确定 这些结果的风险OSA患者的关键预测因素。此外，该项目旨在 评估获得OSA治疗的种族和民族差异，以及中介效应 社会经济和医疗保健因素。该项目如果成功实施， 通过更好地了解生物多样性的益处， 每次治疗，促进个性化医疗，减少OSA的健康差异。

Project Summary Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder that affects up to 38% of North Americans. OSA causes hypoxemia and oxidative stress that lead to increased risks of cardiovascular diseases, type 2 diabetes and various chronic conditions. It also contributes to health disparities as racial and ethnic minority groups are more likely to experience delay in diagnosis and treatment than non-Hispanic Whites, along with the fact that these minorities may have a higher prevalence of OSA. Treatments of OSA, including continuous positive airway pressure (CPAP) and upper airway surgery, are effective in relieving patients' hypopneic symptoms and therefore also thought to reduce the risks of these morbidities. However, previous studies on CPAP did not show significant impact on these outcomes and findings remain inconclusive due to poor compliance of the participants. In addition, literature regarding the long-term benefits of upper airway surgery is extremely lacking. It is also important to characterize OSA patients who will have higher risks of long-term morbidities. The proposed project will leverage the big data from the National Institutes of Health All of Us Research Program to study the long-term effects of CPAP and surgery on downstream morbidities, and to identify critical predictors for OSA patients who are at risk of these outcomes. In addition, the project aims to evaluate the racial and ethnical disparities in access to OSA treatment, and the mediation effect of socioeconomic and healthcare factors. The project, if successfully carried out, should have important scientific and social implications by providing a better understanding of the benefit of each treatment, facilitating personalized medicine, and reducing health disparities in OSA.