Nocturnal Rostral Fluid Shifts In Stroke Patients With Sleep Apnea

 描述（由申请人提供）：卒中是美国成人残疾的主要原因，也是第四大死亡原因，在少数人群中发病率较高。超过一半的缺血性中风患者患有睡眠呼吸暂停，这是一种非常常见和重要的中风预后不良的预测因素，包括死亡和身体残疾。这种高患病率的原因知之甚少，由于对现有治疗的依从性差，睡眠呼吸暂停的治疗在卒中人群中是一个特别的挑战。更好地了解中风后睡眠呼吸暂停的病理生理学可能会产生新的，更耐受的治疗目标。白天腿部的积液可能在夜间重新分配到更多的吻侧隔室。通过咽部变窄和气道扩张性增加，这些液体转移已被证明有助于某些人群的睡眠呼吸暂停。在中风患者中，夜间吻侧液体转移尚未进行研究，其中活动能力受损和医源性液体超负荷是常见的。该项目的母研究，即Corpus Christi睡眠呼吸暂停（BASIC）项目中的脑发作监测，是一项正在进行的基于人群的卒中监测研究，该研究确定了德克萨斯州Nueces县的所有卒中病例。该项目在美国最大的少数民族西班牙裔和非西班牙裔白人中取得了许多关于中风的重要发现，其相关研究（BASIC-睡眠呼吸暂停项目（BASIC-S））开始对中风后睡眠呼吸暂停的流行病学产生有价值的新见解。BASIC将继续识别Nueces县的所有缺血性中风，并将提供详细的基线信息，而BASIC-S将在研究期间的部分时间内提供睡眠呼吸暂停测试和经验证的便携式心肺测试。在当前的应用中，我们将辅助研究添加到BASIC项目中，包括急性中风期间的颈围和腿围以及生物阻抗谱测量。我们建议将这些措施与基线卒中后睡眠呼吸暂停评估和卒中结局联系起来。鉴于招募目前正在进行中，并将于2018年5月31日停止，因此必须尽快开始新的评估，以最大限度地提高样本量和把握度，以实现给定的研究目标。这项辅助研究将使我们能够以一种包含成本的方式回答有关双种族社区中风后睡眠呼吸暂停病理生理学的重要，新颖的问题，因为我们将使用现有的基础设施进行病例识别和睡眠呼吸暂停评估。认识到夜间喙部液体变化将建议简单，可耐受的治疗目标，以改善一个重要的和常见的疾病，睡眠呼吸暂停，在一个毁灭性的疾病，中风，在最大和增长最快的美国少数民族人口。

 DESCRIPTION (provided by applicant): Stroke, the leading cause of adult disability in the US and the fourth leading cause of death, has a higher incidence in minority populations. More than half of ischemic stroke patients have sleep apnea, a very common and important predictor of poor stroke outcomes including death and physical disability. Reasons for this high prevalence are poorly understood, and treatment of sleep apnea is a particular challenge in the stroke population due to poor compliance with existing treatments. A better understanding of the pathophysiology of post-stroke sleep apnea could yield new, more tolerable targets for treatment. Daytime fluid pooling in the legs may be redistributed at night into more rostral compartments. Through pharyngeal narrowing and increased airway collapsibility, these fluid shifts have been shown to contribute to sleep apnea in some populations. Nocturnal rostral fluid shifts have not been investigated in stroke patients, where impaired mobility and iatrogenic fluid overload are common. The parent study for this project, the Brain Attack Surveillance in Corpus Christi Sleep Apnea (BASIC) project, is an ongoing population-based stroke surveillance study that identifies all stroke cases in Nueces County, Texas. This project has made many important discoveries about stroke in Hispanics, the largest minority group in the US, and non-Hispanic whites, and its related study (BASIC-Sleep Apnea Project (BASIC-S)) is beginning to yield valuable new insights into the epidemiology of post-stroke sleep apnea. BASIC will continue to identify all ischemic strokes in Nueces County and will provide detailed baseline information while BASIC-S will provide sleep apnea testing with a validated portable cardiopulmonary test for part of the study period. In the current application, we add ancillary studies to the BASIC project including neck and leg circumference and bioimpedance spectroscopy measurements in the acute stroke period. We propose to relate these measures to the baseline post-stroke sleep apnea assessments and stroke outcomes. Given that recruitment is currently underway and will cease May 31, 2018, it is critical to begin the new assessments as soon as possible to maximize the sample size and power for the given study objectives. This ancillary study will allow us to answer important, novel questions about the pathophysiology of sleep apnea post-stroke within a bi-ethnic community in a cost-containing fashion, as we will use existing infrastructure for case identification and sleep apnea assessment. Recognition of nocturnal rostral fluid shifts will suggest targets for simple, tolerable treatments to ameliorate an important and common disorder, sleep apnea, in a devastating disease, stroke, in the largest and fastest growing US minority population.