The Contribution of Ventilatory Instability to Sleep Disordered Breathing in Pulmonary Hypertension

通气不稳定对肺动脉高压患者睡眠呼吸障碍的影响

• 批准号: 9051940
• 负责人: Jeremy Elliot Orr
• 金额: $ 6.91万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9051940
• 关键词: Accounting; Acetazolamide; Adherence; Apnea; Attention; Back; Blood Circulation; Blood capillaries; Breathing; California; Categories; Central Sleep Apnea; Characteristics; Cheyne-Stokes Respiration; Continuous Positive Airway Pressure; Critical Care; Data; Development; Diagnostic; Disease; Failure; Fluid Shifts; Follow-Up Studies; Future; Health; Heart; Heart Atrium; Heart failure; High Prevalence; Internal Medicine; Investigation; Lead; Left; Low Cardiac Output; Lung; Measurement; Measures; Medicine; Mentorship; Modeling; Modification; Newly Diagnosed; Obstruction; Obstructive Sleep Apnea; Oxygen; Pathway interactions; Patients; Population; Predisposition; Prevalence; Pulmonary Edema; Pulmonary Hypertension; Pulmonary artery structure; Research; Right Ventricular Function; Risk Factors; Role; Severities; Signal Transduction; Sleep; Sleep Apnea Syndromes; Snoring; System; Techniques; Testing; Time; Tongue; Universities; Vasodilator Agents; Ventricular; Visit; airway muscle; capillary; cardiac resynchronization therapy; clinically relevant; falls; hemodynamics; improved; individualized medicine; interest; neuroregulation; novel; personalized medicine; pressure; programs; pulmonary arterial hypertension; respiratory; response; treatment effect; treatment response

 DESCRIPTION (provided by applicant): Jeremy E. Orr, MD is a fellow in the Division of Pulmonary and Critical Care Medicine at the University of California San Diego. He has a background in Internal Medicine, Pulmonary and Critical Care Medicine, and Sleep Medicine. Most recently, he has been interested in the role of unstable ventilatory control as a potential mechanism for sleep disordered breathing (SDB). Under the mentorship of Dr. Atul Malhotra and Dr. Robert Owens, his research program will investigate the hypothesis that increased time delay between the lungs and neural control centers for breathing (termed "circulatory delay") results in instability, which in turn causes SDB. The study will look at patients with pulmonary arterial hypertension (PAH), who may have right ventricular failure, but lack other known predisposition to SDB. Subjects will undergo sleep testing to determine the presence and characteristics of SDB in this group. The study will then utilize clinically available hemodynamic data and quantitative analysis of sleep study data to determine the relationship between circulatory delay, control stability, and sleep disordered breathing. Many subjects will subsequently be treated clinically for their pulmonary hypertension with selective pulmonary vasodilator therapy, which is expected to improve pulmonary artery pressures and right ventricular function. Follow up study visits will determine the effect of this treatment on SDB, and whether any change is attributable to improvements in circulatory delay and control stability. Thus, this study seeks to move past correlation to a causal pathway between circulatory delay and sleep disordered breathing. Although the proposed study is focused on a specific group, the results will be applicable to a broader category of patients - particularly those with right heart failure and/or low cardiac output - and could help determine management of sleep disordered breathing in such patients. This research will help to advance a more comprehensive model of SDB, allowing clinicians and patients to move beyond the one-size-fits-all approach using CPAP to more individualized treatment.

 描述（由申请人提供）：Jeremy E.医学博士奥尔是加州圣地亚哥大学肺部和重症监护医学部的研究员。他有内科，肺和重症监护医学和睡眠医学的背景。最近，他对不稳定的呼吸控制作为睡眠呼吸障碍（SDB）的潜在机制的作用感兴趣。在Atul Malhotra博士和Robert Owens博士的指导下，他的研究计划将调查肺和呼吸神经控制中心之间的时间延迟增加（称为“循环延迟”）导致不稳定，从而导致SDB的假设。这项研究将着眼于肺动脉高压（PAH）患者，他们可能患有右心室衰竭，但缺乏其他已知的SDB易感性。受试者将接受睡眠测试，以确定该组中SDB的存在和特征。然后，该研究将利用临床可用的血流动力学数据和睡眠研究数据的定量分析来确定循环延迟、控制稳定性和睡眠呼吸障碍之间的关系。许多受试者随后将接受选择性肺血管扩张剂治疗以临床治疗其肺动脉高压，预期可改善肺动脉压和右心室功能。随访研究访视将确定该治疗对SDB的影响，以及任何变化是否可归因于循环延迟和控制稳定性的改善。因此，这项研究试图将过去的相关性转移到循环延迟和睡眠呼吸障碍之间的因果通路。虽然这项研究的重点是一个特定的群体，但结果将适用于更广泛的患者类别-特别是那些右心衰竭和/或低心输出量的患者-并有助于确定这些患者睡眠呼吸障碍的管理。这项研究将有助于推进一个更全面的SDB模型，使临床医生和患者能够超越使用CPAP的一刀切方法，进行更个性化的治疗。