Impact of Positive Airway Pressure Therapy on Clinical Outcomes in Older Veterans with Chronic Obstructive Pulmonary Disease and Comorbid Obstructive Sleep Apnea (Overlap Syndrome)

气道正压通气治疗对患有慢性阻塞性肺疾病和共病阻塞性睡眠呼吸暂停（重叠综合征）的老年退伍军人临床结果的影响

• 批准号: 10599838
• 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: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10599838
• 关键词: Aging; Alzheimer' s Disease; Arousal; Award; Brain; Cardiovascular system; Caring; Catchment Area; Chronic; Chronic Obstructive Pulmonary Disease; Chronic lung disease; Clinical; Cognitive; Cognitive deficits; Complex; Continuous Positive Airway Pressure; Data; Dementia; Disease; Drowsiness; Early treatment; Education; Elderly; Feasibility Studies; Functional disorder; Future; General Population; Goals; Health; Healthcare; Hospitalization; Hypercapnia; Hypoventilation; Hypoxia; Impaired cognition; Impairment; Individual; Injury; Long-Term Care for Elderly; Medical; Memory; Mental Depression; Neurocognitive; Neurocognitive Deficit; Neurodegenerative Disorders; Obstructive Sleep Apnea; Outcome; Oxygen; Pathway interactions; Patients; Pilot Projects; Population; Prevalence; Probability; Quality of life; Questionnaires; Rehabilitation therapy; Research; Research Design; Research Priority; Risk; Short-Term Memory; Sleep; Sleep Disorders; Sleep Fragmentations; Sleep disturbances; Stroke; Symptoms; Syndrome; Time; Veterans; airway obstruction; cognitive enhancement; cognitive function; cognitive testing; comorbidity; disability; effective therapy; effectiveness evaluation; experience; falls; improved; improvement on sleep; innovation; mild cognitive impairment; military veteran; mortality; novel; pharmacologic; poor sleep; positive airway pressure; pressure; prospective; randomized, controlled study; sleep health; sleep quality; ventilation; verbal

Cognitive dysfunction in the aging and elderly Veteran population confers a risk for increased mortality. Cognitive deficits are prevalent in neurodegenerative disorders, like Alzheimer’s disease, stroke, and depression. More recently, obstructive sleep apnea (OSA) has been recognized as a factor contributing to cognitive deficits via intermittent hypoxia and sleep fragmentation. Moreover, chronic lung disease, particularly COPD, is also thought to be related to cognitive decline, possibly through sleep fragmentation and hypoxic injury to the brain. Our pilot project data on the impact of OSA-COPD Overlap Syndrome in older Veterans provides evidence that the presence of comorbid OSA and COPD does contribute to sleep disturbances, impairment in certain domains of cognitive function and an overall reduced quality of life (QoL). Given that PAP therapy has been shown to improve neurocognitive function and sleepiness in moderate to severe OSA, probably by reducing arousals and hypoxia, as well by improving sustained hypoxia due to COPD, it will likely also have a positive impact on sleep and cognitive impairment in patients with moderate to severe degree of Overlap Syndrome. The results from the pilot project speak to the feasibility of conducting a future longer study of the impact of treatment with positive airway pressure therapy (PAP) vs. conservative care in older Veterans with Overlap Syndrome. Our future project builds on the pilot data to study the following aims: Aim1 will investigate the effect of PAP therapy vs. conservative care for 6 months on daytime sleepiness and sleep quality in older Veterans with OVS. Aim 2 will study the effect of PAP vs. conservative care for 6 months on neurocognitive function older Veterans with OVS. Aim 3 will determine the effect of PAP vs. conservative care for 6 months on QoL in older Veterans with OVS. The approach will be a prospective parallel group randomized controlled study, wherein we will administer sleep and QoL questionnaires, and a battery of cognitive tests, before and after 6 mo of PAP therapy or conservative management to evaluate the above outcomes. Our goal is to enhance rehabilitation from comorbid chronic conditions that frequently impact sleep and cognitive function, with the ultimate objective of improving the overall health and quality of life of elderly Veterans suffering from these disorders.

老年和老年退伍军人中的认知功能障碍增加了死亡率的风险。 认知缺陷普遍存在于神经退行性疾病中，如阿尔茨海默病、中风和 抑郁症。最近，阻塞性睡眠呼吸暂停(OSA)被认为是导致 间歇性低氧和睡眠碎片造成的认知缺陷。此外，慢性肺部疾病，特别是 COPD也被认为与认知能力下降有关，可能是通过睡眠碎片和低氧 脑部受伤。我们关于OSA-COPD重叠综合征对老年退伍军人影响的试点项目数据 提供证据表明，阻塞性睡眠呼吸暂停综合征和慢性阻塞性肺病的并存确实会导致睡眠障碍， 认知功能某些领域的损害和总体生活质量(QOL)的降低。考虑到PAP 治疗已被证明可以改善中到重度阻塞性睡眠呼吸暂停患者的神经认知功能和嗜睡， 可能通过减少觉醒和缺氧，以及改善慢性阻塞性肺病造成的持续性缺氧，它可能会 对中重度高血压患者的睡眠和认知功能障碍也有积极影响 重叠综合症。试点项目的结果说明了今后进行更长期研究的可行性。 老年退伍军人接受正压治疗(PAP)与保守治疗的影响 患有重叠综合症。我们未来的项目将以试点数据为基础，研究以下目标： AIM1将研究PAP疗法与保守护理6个月对日间嗜睡和 老年退伍军人OVS患者的睡眠质量。目的2将研究PAP与保守护理6个月的效果 老年退伍军人OVS神经认知功能的研究目标3将确定PAP与保守性治疗的效果 对老年退伍军人OVS患者进行6个月的生活质量评估。该方法将是一个预期的平行小组 随机对照研究，其中我们将进行睡眠和生活质量问卷调查，以及一系列 认知测试，前后6个月的PAP治疗或保守治疗，以评估上述 结果。我们的目标是加强对经常影响睡眠的慢性共病的康复 和认知功能，最终目标是改善老年人的整体健康和生活质量 患有这些疾病的退伍军人。