Outcomes of Sleep Disorders in Older Men

描述（由申请人提供）：拟议的研究是一项为期5年的竞争性更新研究，老年男性睡眠障碍的结果（mrs睡眠研究）。MrOS睡眠研究旨在通过利用已建立的男性骨质疏松性骨折（MrOS）研究的队列，测试关于社区居住老年人睡眠障碍后果的几个假设。从2003年12月到2005年3月，3135名磁共振成像参与者（达到目标100%）被纳入辅助磁共振成像睡眠研究。全面客观的睡眠评估（包括夜间在家多导睡眠描记仪（PSG）、5天腕部活动描记仪和自我报告的睡眠质量测量）、心血管事件（CVD）事件的判断，以及包括生物标本在内的其他测量，被添加到mrs父母研究的庞大数据集中。在初始周期中，我们发现睡眠呼吸障碍（SDB）和低氧血症是心血管疾病、心律失常、死亡率和非脊柱骨折的重要独立预测因素。我们现在建议继续对mrs睡眠研究队列进行随访，以提供足够的能力来确定与SDB相关的特定CVD结局和疾病特异性死亡率的风险，而不是总体结局（目的1）。通过测试SDB/低氧血症与预后之间观察到的关系的几种潜在机制，初步发现也将在更新中扩展，包括i)可能阐明机制途径的生化决定因素；Ii)肺功能和日间血氧饱和度；iii)客观测量睡眠时间（目标2）。我们进一步建议通过对这些条件进行纵向评估来加强我们关于睡眠与年龄相关条件（包括虚弱，身体和认知功能）的一些横断面研究结果（目标3）。最后，PSG和活动图的重复测量将使我们能够在5年的随访中描述老年男性睡眠特征变化的模式，并确定这些变化的相关性和后果（目的4）。这是一个难得的机会，可以继续对3000多名参与mrs睡眠研究的男性进行随访，并重新检查已经提供了如此丰富数据的队列子集，将为SDB和睡眠模式与随后的发病率和死亡率之间的关系提供新的见解。公共卫生相关性：睡眠障碍非常常见，尤其是在老年人中。该研究的建议更新，老年男性睡眠障碍的结果，将为睡眠呼吸障碍、低氧血症和睡眠模式（全面客观地测量）与随后的发病率和死亡率风险之间的关系提供新的见解。几个机械途径将探索，除了扩展

DESCRIPTION (provided by applicant): The proposed study is a 5-year competitive renewal of the study, Outcomes of Sleep Disorders in Older Men (MrOS Sleep Study). The MrOS Sleep Study was designed to test several hypotheses regarding consequences of sleep disorders in community-dwelling older, by taking advantage of the established cohort that was enrolled for the Osteoporotic Fractures in Men (MrOS) study. From December 2003 through March 2005, 3135 MrOS participants (> 100% of goal) were enrolled into the ancillary MrOS Sleep Study. Comprehensive and objective assessments of sleep (including overnight in-home polysomnography (PSG), 5-day wrist actigraphy and self-reported measures of sleep quality), adjudication of incident cardiovascular (CVD) events, and other measures including biological specimens were added to the expansive dataset of the MrOS parent study. During the initial cycle, we identified sleep disordered breathing (SDB) and hypoxemia as significant independent predictors of CVD, arrhythmias, mortality and non-spine fractures. We now propose continued follow-up of the MrOS Sleep Study cohort to provide sufficient power to determine risk of specific CVD outcomes and disease-specific mortality associated with SDB, rather than aggregate outcomes (Aim 1). Initial findings will also be extended in the renewal by testing several potential mechanisms for the observed relationships between SDB/hypoxemia and outcomes, including i) biochemical determinants that may elucidate mechanistic pathways; ii) lung function and daytime oxygen saturation levels; and iii) objectively measured sleep duration (Aim 2). We further propose to strengthen several of our cross- sectional findings relating sleep to age-related conditions including frailty, physical and cognitive function, by performing longitudinal assessments of these conditions (Aim 3). Finally, repeat measures of PSG and actigraphy will enable us to characterize patterns of change in sleep characteristics among older men during 5 years of follow-up, and to determine the correlates and consequences of these changes (Aim 4). This rare opportunity to continue follow-up in over 3000 men who participated in the original wave of the MrOS Sleep Study, and to re-examine a subset of the cohort who have already contributed such a wealth of data, will provide new insights into the relationships between SDB and sleep patterns with subsequent morbidity and mortality. PUBLIC HEALTH RELEVANCE: Sleep disorders are very common, particularly in older adults. The proposed renewal of the study, Outcomes of Sleep Disorders in Older Men, will provide new insights into the relationships between sleep disordered breathing, hypoxemia, and sleep patterns (measured comprehensively and objectively) with subsequent risk of morbidity and mortality in a large cohort of community-dwelling older men. Several mechanistic pathways will be explored, in addition to extending follow-up to allow for analysis of more specific CVD outcomes and disease-specific mortality (rather than aggregate outcomes).