Epidemiology of Sleep-Disordered Breathing in Adults

描述（由申请人提供）：睡眠呼吸障碍（SDB），描述为睡眠期间呼吸暂停和呼吸不足事件的频率，被广泛认为是一种高度流行但诊断不足的疾病，在高血压、心血管和脑血管疾病、认知功能受损、嗜睡、日间功能减退和过早全因死亡和心血管死亡中具有重要作用。过去20年的人群研究已经确定了SDB的高患病率，并开始确定SDB的相关因素和结果，但必须解决关键问题，以制定关于SDB预防和治疗的临床和公共卫生政策。在美国，将改变SDB负担的重要时期效应正在发生，包括第二次世界大战后出生的大型队列的老龄化，在中年期间对SDB风险因素有不同暴露的老年人的生存率提高，以及肥胖流行。在这些新的条件下，缺乏解决SDB公共卫生负担的数据。本文提出的研究旨在解决理解未治疗SDB负担的差距。随着威斯康星州睡眠队列研究（SDB和其他睡眠障碍的纵向研究）持续5年，我们将继续随访基线时年龄为30-60岁的男性和女性的社区样本（n= 1522），他们在继续期间将年龄增加到55-85岁。通过长达25年的数据，以及从中年到老年的SDB数据和其他因素的个体轨迹，我们将最佳地估计未经治疗的SDB在临床前和临床明显的心血管和脑血管疾病（CVD/卒中），认知障碍和慢性日间功能障碍中的作用。我们还将调查与年龄相关的风险因素对睡眠障碍的影响。为了实现这些目标，我们将进行随访方案，包括过夜多导睡眠图，最先进的身体形态测量，包括DXA，超声心动图和血管成像，神经心理测试组合，以及其他测试，以扩展我们关于SDB状态，风险因素和结局的丰富数据。 公共卫生相关性：从拟议的纵向威斯康星州睡眠队列研究中发现，SDB的发生和进展，从中年后期到老年人的过渡，以及SDB在发病率和死亡率的发展中的作用，将有助于公共卫生意义所需的新知识。这些发现将为临床决策提供信息，包括应确定SDB的严重程度，是否应将亚组作为病例发现的目标，并减少由于基于不正确的SDB患者刻板印象的转诊和治疗而造成的不公平。这些发现还将为公共卫生政策提供有关所需新资源的信息，旨在制定目标以提高对SDB的认识并预防SDB发生和进展的公共计划，以及将SDB纳入联邦健康促进和监测计划。

DESCRIPTION (provided by applicant): Sleep disordered breathing (SDB), described by the frequency of apnea and hypopnea events during sleep, is widely recognized as a highly prevalent but under-diagnosed condition that has a significant role in hypertension, cardiovascular and cerebrovascular disease, impaired cognitive function, hypersomnolence, decrements in daytime functioning and premature all-cause and cardiovascular mortality. Population studies over the 20 years have established the high prevalence of SDB and begun to identify the correlates and outcomes of SDB, but critical questions must be addressed to craft clinical and public health policy regarding the prevention and treatment of SDB. Important period effects that will change the SDB burden are occurring in the US, including aging of the large post World War II birth cohort, enhanced survival of older adults who have had different exposures during midlife to SDB risk factors, and an obesity epidemic. Data to address the public health burden of SDB under these new conditions are lacking. The research proposed here is designed to address the gap in understanding the burden of untreated SDB. With a 5-year continuation of the Wisconsin Sleep Cohort Study, a longitudinal study of SDB and other sleep disorders, we will continue to follow a community sample (n= 1522) of men and women, 30-60 years of age at baseline, who will have aged to 55-85 years over the continuation. With data spanning up to 25 years, with individual trajectories of data on SDB and other factors from middle to older age, we will optimally estimate the role of untreated SDB in preclinical and clinically evident cardiovascular and cerebrovascular disease (CVD/stroke), cognitive impairment, and chronic daytime dysfunction. We will also investigate the impact of age-related risk factors on sleep disorders. To achieve these goals, we will conduct follow-up protocols with overnight polysomnography, state of the art body habitus measures including DXA, echocardiography and vascular imaging, neuropsychologic test batteries, and other tests to extend our rich data on SDB status, risk factors, and outcomes. PUBLIC HEALTH RELEVANCE: The finding from the proposed longitudinal Wisconsin Sleep Cohort Study on the occurrence and progression of SDB, in a population transitioning from late middle to older age, and on the role SDB has in the development of morbidity and mortality will contribute needed new knowledge of public health significance. The findings will inform clinical decision making regarding what level of severity of SDB should be identified, whether subgroups should be targeted for case-finding, and decrease inequities due to referral and treatment based on incorrect SDB patient stereotypes. The findings will also inform public health policy regarding needed new resources, public programs designed to set goals to increase awareness of SDB, and to prevent SDB occurrence and progression, and to include SDB in federal health promotion and monitoring programs.