Insomnia and Sleep Disordered Breathing in Seniors: A Longitudinal Outcome Study

描述(由申请者提供)：失眠症状，如启动或维持睡眠困难，在美国影响大约1000万老年人。在纵向研究中发现，失眠症状的出现与抑郁症、事故和跌倒的风险增加有关，并可能导致死亡率增加。然而，当前文献的一个主要局限性是，通过多导睡眠图得出的客观睡眠测量尚未被纳入对失眠结果的大型研究中，部分原因是失眠在很大程度上是一种主观诊断。然而，多导睡眠图对于诊断其他常见的睡眠障碍是必要的，例如与睡眠相关的呼吸障碍。这在老年人群体中尤其相关，那里与睡眠相关的呼吸障碍的患病率可能高达25%，而且病史/检查是不可靠的指标。目前这项建议的研究人员在之前的研究中观察到，29%的出现失眠症状的老年人可能会发生失眠和睡眠相关的呼吸障碍。此外，这种并存状态与增加的功能损伤率有关。然而，最令人担忧的是初步数据表明，患有共病状态的研究参与者的死亡率高于单独患有任何一种疾病的参与者。这些发现导致研究人员假设，与任何一种情况相比，失眠和睡眠相关的呼吸障碍与显著增加的不良后果有关。他们从一项病例对照研究中收集了大量数据，该研究对200名患有和不患有失眠的老年人进行了研究，其中包括多导睡眠图和精神运动评估。他们建议在八年的随访期内重新评估这一队列，以实现以下具体目标：1)确定失眠和与睡眠相关的呼吸障碍是否与功能障碍和死亡率的增加相关；以及2)评估共存的与睡眠相关的呼吸障碍是否是持续出现失眠主诉的风险因素。这项研究建议与R21机制的目标一致，因为它将收集对这一领域未来大型研究的设计至关重要的探索性数据，并检查了一种经历了有限调查的障碍，因此它提供了显著扩大我们对老年睡眠障碍的理解的机会。目前，失眠和睡眠相关的呼吸障碍在很大程度上被视为两个独立的临床实体。如果像初步数据显示的那样，共病失眠和睡眠相关的呼吸障碍是相互关联的，并导致不良后果风险增加，这项研究的发现将显著改变睡眠医学的实践和数百万患有睡眠障碍的老年人所接受的护理。公共卫生相关性：失眠和睡眠呼吸暂停(睡眠期间的异常呼吸模式)在老年人中很常见，每一种都可能导致疾病或死亡风险增加。在大约30%的老年人中，失眠和睡眠呼吸暂停可能同时存在，这种联合状态可能会导致严重的不良后果；然而，很少有研究检查这种联合状态的长期结果。这项研究研究将专门探讨这些长期结果，以帮助为未来的研究建立框架，以确定将这些风险降至最低的有效方法。

DESCRIPTION (provided by applicant): Insomnia symptoms, such as difficulty initiating or maintaining sleep, affect approximately ten million older adults in the United States. The presence of insomnia symptoms has been found in longitudinal studies to be associated with increased risks of depression, accidents, and falls and may lead to increased mortality. One major limitation of the current literature, however, is that objective measures of sleep derived by polysomnography have not been incorporated into large studies of insomnia outcomes in part because insomnia is largely a subjective diagnosis. However, polysomnography is necessary for the diagnosis of other common sleep disorders, such as sleep-related breathing disorder. This is especially relevant in older adults populations, where the prevalence of sleep-related breathing disorder may be as high as 25% and history/exam are unreliable indicators. The investigators of the current proposal have observed in prior research that comorbid insomnia and sleep-related breathing disorders may occur in 29% of older adults who present with insomnia symptoms. Furthermore, this comorbid state is associated with increased rates of functional impairment. Most concerning, however, is preliminary data that suggests that mortality rates in study participants with the comorbid state are higher than those with either condition alone. These findings have led the study investigators to hypothesize that comorbid insomnia and sleep-related breathing disorder is associated with significantly increased adverse outcomes relative to either condition alone. They have gathered extensive data from a case-control study of 200 older adults with and without insomnia that includes polysomnography and psychomotor assessments. They propose re-evaluating this cohort at an eight year follow-up period for the following specific aims: 1) to determine if insomnia and sleep-related breathing disorder are associated with increased degrees of functional impairment and mortality; and 2) to assess if the presence of co-existing sleep-related breathing disorder is a risk factor for persistence of insomnia complaints. This research proposal is consistent with the goals of an R21 mechanism in that it will gather exploratory data crucial to the design of future large studies in this area and it examines a disorder that has undergone limited investigation, thus it provides the opportunity to significantly expand our understanding of geriatric sleep disorders. Currently, insomnia and sleep-related breathing disorders are largely viewed as two separate clinical entities. If, as suggested by the preliminary data, comorbid insomnia and sleep-related breathing disorder are inter-related and lead to increased risk of adverse outcomes, the findings from this study will significantly alter the practice of sleep medicine and the care received by millions of older adults with sleep disorders. PUBLIC HEALTH RELEVANCE: Insomnia and sleep apnea (abnormal breathing patterns during sleep) are common in older adults and may each lead to increased risk of disease or death. Insomnia and sleep apnea may exist together in older adults in about 30% of cases and this combined state may be lead to significant adverse consequences; however, few studies have examined the long-term outcomes of this combined state. This research study will specifically explore these long-term outcomes to help establish the framework for future studies that identify effective methods to minimize these risks.