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.

认知功能障碍的老龄化和老年退伍军人人口赋予的死亡率增加的风险。 认知缺陷在神经退行性疾病中普遍存在，如阿尔茨海默病、中风和阿尔茨海默病。 萧条最近，阻塞性睡眠呼吸暂停（OSA）已被认为是导致睡眠呼吸暂停的一个因素。 间歇性缺氧和睡眠片段导致的认知缺陷。此外，慢性肺病，特别是 慢性阻塞性肺病也被认为与认知能力下降有关，可能是通过睡眠片段化和缺氧引起的 对大脑的伤害。我们的试验项目数据对老年退伍军人中OSA-COPD重叠综合征的影响 提供了证据表明，合并OSA和COPD的存在确实有助于睡眠障碍， 某些认知功能领域的损害和整体生活质量（QoL）降低。鉴于PAP 治疗已经显示出改善中度至重度OSA的神经认知功能和嗜睡， 可能通过减少觉醒和缺氧，以及通过改善COPD引起的持续缺氧， 对中度至重度抑郁症患者的睡眠和认知障碍也有积极影响。 重叠综合征。试点项目的结果表明，今后进行更长时间的研究是可行的 气道正压通气治疗（PAP）与保守治疗对老年退伍军人的影响 重叠综合症我们未来的项目建立在试点数据的基础上，研究以下目标： 目的1将研究PAP治疗与保守治疗6个月对日间嗜睡的影响， 老年OVS退伍军人的睡眠质量。目的2将研究PAP与保守治疗6个月的效果 神经认知功能的影响。目标3将确定PAP与保守治疗的效果 在患有OVS的老年退伍军人中进行6个月的QoL护理。该方法将是一个前瞻性的平行组 随机对照研究，其中我们将管理睡眠和QoL问卷，以及一组 在PAP治疗或保守治疗6个月前后进行认知测试，以评估上述情况 结果。我们的目标是加强经常影响睡眠的共病慢性疾病的康复 和认知功能，最终目的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。