Women's Health Initiative Sleep Hypoxia Effects on Resilience (WHISPER)

总结 老年人的睡眠障碍和干扰很常见，但往往未被诊断和治疗。大多数的流行 睡眠问题随着年龄的增长而增加，并且可能归因于潜在的医学或精神疾病，药物使用， 或睡眠异常，例如称为睡眠呼吸障碍（SDB）的上呼吸道阻塞。令人信服的流行病学 数据表明SDB，特别是间歇性缺氧（IH），在增加心血管疾病（CVD），癌症和认知功能障碍的发病率方面， 损伤，包括阿尔茨海默病（AD）和相关痴呆。虽然其他研究已经研究了SDB与 关于男性和年轻女性心血管疾病风险的研究，大多数是横断面的，或者在很大程度上排除了老年女性， 有很高的血管疾病风险没有大型临床研究前瞻性地研究SDB对癌症发病率的作用， 尽管动物研究的有力证据表明低氧血症通过多种途径促进肿瘤生长， 机制，以及认知轨迹和事件轻度认知障碍（MCI）和老年人的AD。迄今为止，没有前科 一项有充分把握的研究检查了SDB对老年妇女这些不良健康结局的预测价值。我们建议 利用妇女健康倡议（WHI）提供的坚实基础设施的独特而丰富但时间有限的资源 以及一个广泛的数据库，以解决有关SDB的作用和其他睡眠障碍对穷人的影响的关键问题。 健康和认知结果在一个大的，良好的特点队列的老年妇女。我们将利用WHI提供的资源 位于维克森林的东南区域中心，负责心血管疾病、癌症、认知评估和 MCI/AD;布里格姆妇女医院/哈佛和加州太平洋医学中心提供睡眠、心血管疾病和癌症方面的专业知识。 我们将使用经过验证的低负担数据收集策略，确保在一小部分数据中具有不同的地理代表性。 与基于诊所的评估相关的成本，包括：1）腕戴式设备，以提供持续的睡眠氧气测量 基线时的去饱和度、心率和活动; 2）邮件和电话评估;以及3）与WHI及其辅助机构共享数据 问题研究睡眠研究将使用脉搏血氧仪和活动记录仪在5000名已经接受CVD随访的女性中进行 和癌症的结果通过其他WHI的努力。将收集3年随访期间判定的癌症和CVD结局， 认知功能将通过电话进行评估，随访3年，使用为 WHI记忆研究。这些数据可以提供科学的动力，以支持使用新出现的无处不在的可访问和 作为高危患者常规临床护理的一部分，可提供具有成本效益的低氧血症评估的负担得起的设备 SDB对CVD和其他关键健康结果的负面影响。

SUMMARY Sleep disorders and disturbances in older adults are common, yet frequently undiagnosed and untreated. The prevalence of most sleep problems increases with advancing age and may be attributable to underlying medical or psychiatric conditions, medication use, or sleep abnormalities such as upper airway obstruction referred to as sleep-disordered breathing (SDB). Compelling epidemiological data implicate SDB, particularly intermittent hypoxia (IH), in increasing rates of cardiovascular disease (CVD), cancers and cognitive impairment, including Alzheimer's disease (AD) and related dementias. Although other studies have examined the association of SDB on CVD risk in men and younger women, most are cross-sectional in nature or largely exclude elderly women who are characteristically at high risk of significant vascular disease. No large clinical study has prospectively examined the role of SDB on cancer incidence and aggressiveness, despite strong evidence from animal studies indicating that hypoxemia promotes tumor growth via multiple mechanisms, and on cognitive trajectory and incident mild cognitive impairment (MCI) and AD in older adults. To date, no prior sufficiently powered study has examined the predictive value of SDB for these poor health outcomes in elderly women. We propose to capitalize on the unique and rich, but time-limited resources of the Women's Health Initiative (WHI) that provide a solid infrastructure and an extensive data repository to address key questions regarding the role of SDB and other measures of disturbed sleep on poor health and cognitive outcomes in a large, well-characterized cohort of elderly women. We will leverage resources provided by the WHI Southeast Regional Center at Wake Forest for the conduct of the study and expertise in CVD, cancer, cognitive assessment and MCI/AD; and by Brigham and Women's Hospital/Harvard and California Pacific Medical Center for expertise in sleep, CVD, and cancer. We will use a validated, low burden strategy for data collection that ensures diverse geographical representation at a fraction of the cost associated with clinic-based assessments, including: 1) wrist-worn devices to provide continuous sleep measurements of oxygen desaturation, heart rate, and activity at baseline; 2) mail and telephone assessments; and 3) data sharing with WHI and its ancillary studies. Sleep studies will be conducted using pulse oximetry and actigraphy in 5000 women who are already being followed for CVD and cancer outcomes through other WHI efforts. Adjudicated cancer and CVD outcomes will be collected for 3 years of follow-up, and cognitive function will be assessed via telephone for 3 years of follow-up using well-established validated protocols developed for the WHI Memory Studies. These data may provide the scientific impetus to support the use of new emerging ubiquitously accessible and affordable devices that could provide cost-effective assessments of hypoxemia as part of routine clinical care in patients at highest risk for the negative effects of SDB on CVD and other critical health outcomes.