The Sleep Heart Health Study

描述（由申请人提供）：一般人群中中年人的睡眠呼吸障碍（SDB）患病率估计为男性4%，女性2%，老年人的患病率更高。回顾性和横断面研究的累积证据表明，SDB与心血管和脑血管疾病（CVD）的存在以及随之而来的死亡率和发病率增加有关。然而，很少有前瞻性数据表明SDB是否是CVD发展的独立危险因素。睡眠心脏健康研究（SHHS）是一项纵向多中心队列研究，始于1994年，旨在确定SDB的心血管后果。最初，SHHS招募了6441名参与者（1996-98）进行家庭多导睡眠图（PSG）和其他CVD和睡眠相关数据的采集。另一项PSG重复检查（2001-2003年）刚刚完成。死亡率和发病率随访正在进行中，但事件发生率不足以提供SDB对CVD事件和死亡率影响的稳定估计。此外，SHHS的独特资源是其约10，000个PSG，相关评分和临床协变量数据的档案。为科学界提供这些数据一直是SHHS的一个重要目标，并且有可能在从信号处理的新方法到识别独特的流行病学关联的合作研究中实现重大利益。因此，本申请建议对SHHS队列进行额外的死亡率和发病率随访，继续纵向和横断面数据 分析的重点是SDB作为心血管事件和高血压的风险因素，以及开发基础设施，以方便一般科学界访问SHHS PSG档案。这些目标将通过实现以下具体目标来实现：1）继续对SHHS队列进行随访，以评估SDB作为高血压事件以及CVD事件和复发性CVD事件的风险因素; 2）描述SDB的自然史，并确定RDI的变化（呼吸暂停或呼吸不足数/睡眠小时）与中期和偶发CVD事件的风险相关; 3）表征SDB和SDB进展与生活质量和日间嗜睡指标之间的关系; 4）使用PSG数据以及先前从父母组群收集的风险因素数据，开发与SDB相关的临床和流行病学适用的风险模型;以及5）开发基础设施，以促进数据共享，合作分析，并向科学界发布数据分析工具和研究结果。实现这些目标将提供有关SDB对公共卫生影响的重要信息。

DESCRIPTION (provided by applicant): The prevalence of sleep disordered breathing (SDB) in middle aged persons in the general population is estimated to be 4 percent in men and 2 percent in women with higher rates observed in the elderly. Accumulating evidence from retrospective and cross-sectional studies suggest that SDB is associated with the presence of cardiovascular and cerebrovascular disease (CVD) and consequent increased mortality and morbidity. However, there is little prospective data indicating whether SDB is an independent risk factor for the development of CVD. The Sleep Heart Health Study (SHHS) is a longitudinal multi-center cohort study that was started in 1994 to determine the cardiovascular consequences of SDB. Initially, SHHS recruited 6441 participants (1996-98) to undergo in-home polysomnography (PSG) and acquisition of other CVD and sleep-related data. Another examination with repeat PSG (2001-2003) has just been completed. Mortality and morbidity follow-up is ongoing, but event rates have been insufficient to provide stable estimates of the effect of SDB on incident CVD and mortality. Additionally, a unique resource of SHHS is its archive of approximately 10,000 PSGs, associated scoring and clinical covariate data. Providing the scientific community access to this data has always been an important goal of SHHS, and has the potential to realize significant benefits in collaborative research ranging from novel methods of signal processing to identifying unique epidemiologic associations. Therefore, this application proposes additional mortality and morbidity follow-up of the SHHS cohort, continuation of longitudinal and cross-sectional data analyses focused on SDB as a risk factor for cardiovascular events and hypertension, and development of an infrastructure to facilitate access by the general scientific community to the SHHS PSG archive. These goals will be achieved by accomplishing the following specific aims: 1) to continue follow-up of the SHHS cohort in order to assess SDB as a risk factor for incident hypertension, and incident and recurrent CVD events; 2) to characterize the natural history of SDB and determine how change in RDI (# apneas or hypopneas/hour of sleep) is related to risk for interim and incident CVD events; 3) to characterize the relationship between SDB and SDB progression with quality of life and indicators of daytime sleepiness; 4) to use the PSG data as well as previous collected risk factor data from parent cohorts to develop a clinically and epidemiologically applicable model of risk relating to SDB; and 5) to develop an infrastructure to facilitate data sharing, collaborative analysis, and dissemination of data analytic tools and research findings to the scientific community. Accomplishing these goals will provide important information concerning the public health impact of SDB.