Cognition After OSA Treatment Among Native American People

研究项目3：摘要 阻塞性睡眠呼吸暂停(OSA)在美国老年人中的患病率高达56%。短期 OSA的神经后果包括认知变化，如注意力不集中和执行能力受损 尽管这些关联的机制尚不清楚，但它们的作用并不明确。阻塞性睡眠呼吸暂停综合症还会增加患阿尔茨海默氏症的风险 疾病及相关痴呆症(ADRD)和轻度认知障碍，以及改变ADRD生物标志物。 气道正压是治疗阻塞性睡眠呼吸暂停综合征的金标准，并在临床试验中改善认知， 包括ADRD患者。尽管美国印第安人肥胖率很高，但肥胖的一个风险因素 无论是阻塞性睡眠呼吸暂停综合症还是ADRD，都没有可靠的基于人群的阻塞性睡眠呼吸暂停综合征患病率估计。OSA也是 可能在美国印第安人中被低估了，数据有力地表明这种可改变的ADRD风险存在差异 因素。因此，我们将生成基于人口的阻塞性睡眠呼吸暂停综合征流行率估计及其与 认知功能，开发新的干预措施，并进行随机实用试验。对于 流行病学部分，我们将招募2个附属于强心研究的研究成员，唯一 美洲印第安人心脑血管疾病的人群研究。我们会放映 450名55岁以上的队列成员居住在2个北部平原保留地为OSA和测量认知 功能。怀疑患有阻塞性睡眠呼吸暂停综合症的参与者将接受WATCHPAT测试，这是FDA批准的睡眠 呼吸暂停诊断仪。结果证实为阻塞性睡眠呼吸暂停综合征的参与者将被转介接受正气道压力治疗。 接受治疗，并有资格参加试验。分析将利用之前收集的数据来确定固定和时间- 阻塞性睡眠呼吸暂停的危险因素各不相同。接下来，我们将使用定性的方法来开发行为干预 修改现有的激励性访谈和电子信息传递协议，以增加压力治疗 坚持不懈。在随机对照试验中，我们将招募300名55岁以上的美国印第安人 接受阻塞性睡眠呼吸暂停的正压治疗的同一强心研究社区。他们将会是 随机接受常规护理，或常规护理加干预。按基准收集数据，3个月 12个月将包括气道正压坚持、睡眠质量、认知功能和血管 ADRD的风险因素。主要结果是气道正压坚持和认知功能， 前者被认为是对后者变化的一种机械解释。我们的具体目标是：1) 评估老年美洲印第安人中阻塞性睡眠呼吸暂停的患病率及其与认知功能的关系 从2个强心脏研究附属研究收集的现有纵向数据中确定阻塞性睡眠呼吸暂停的危险因素； 2)制定行为干预措施并测试其对正压维持和睡眠的影响。 评估干预对认知功能和ADRD血管危险因素的有效性。 这项独特的研究探索了阻塞性睡眠呼吸暂停综合征与认知功能之间的关系， 边疆人口获得专门医疗保健的机会有限。它也迈出了重要的一步 评估阻塞性睡眠呼吸暂停综合征是阻塞性睡眠呼吸暂停综合征和ADRD之间强关联的一种机制。

RESEARCH PROJECT 3: ABSTRACT Prevalence of obstructive sleep apnea (OSA) among older adults in the US is as high as 56%. Short-term neurological consequences of OSA include cognitive changes such as poor attention and impaired executive function, although the mechanisms for these associations are unclear. OSA also increases risk of Alzheimer’s disease and related dementias (ADRD) and mild cognitive impairment, as well as alters ADRD biomarkers. Positive airway pressure is the gold standard treatment for OSA and improves cognition in clinical trials, including patients with ADRD. Although American Indians have a high prevalence of obesity, a risk factor for both OSA and ADRD, no reliable population-based estimates of OSA prevalence exist for AIs. OSA also is likely underdiagnosed in American Indians, and data strongly suggest a disparity in this modifiable ADRD risk factor. Accordingly, we will generate population-based estimates of OSA prevalence and its association with cognitive function, develop a novel intervention, and conduct a randomized pragmatic trial. For the epidemiology component, we will recruit members of 2 studies affiliated with the Strong Heart Study, the only population-based study of cardiovascular and cerebrovascular disease in American Indians. We will screen 450 cohort members ages 55+ living on 2 Northern Plains reservations for OSA and measure cognitive function. Participants with suspected OSA will undergo testing with the WATCHPAT, an FDA-approved sleep apnea diagnostic device. Participants whose results confirm OSA will be referred for positive airway pressure therapy and be eligible for the trial. Analyses will leverage previously collected data to identify fixed and time- varying risk factors for OSA. Next, we will develop the behavioral intervention by using qualitative methods to revise existing protocols for motivational interviewing and electronic messaging to increase pressure treatment adherence. For the randomized controlled trial, we will recruit 300 American Indians ages 55+ from the same Strong Heart Study communities who receive positive airway pressure treatment for OSA. They will be randomized to receive usual care, or usual care plus the intervention. Data collection at baseline, 3 months and 12 months will include positive airway pressure adherence, sleep quality, cognitive function, and vascular risk factors for ADRD. Primary outcomes are positive airway pressure adherence and cognitive function, with the former evaluated as a mechanistic explanation for change in the latter. Our Specific Aims are to: 1) Estimate the prevalence of OSA and its association with cognitive function in older American Indians, and identify OSA risk factors from existing longitudinal data collected by the 2 Strong Heart-Study-affiliated studies; 2) Develop the behavioral intervention and test its effect on positive airway pressure adherence and sleep quality; and 3) Assess the intervention’s effectiveness on cognitive function and ADRD vascular risk factors. This unique study explores the relationship between OSA and cognitive function in an understudied, at-risk, frontier population with limited access to specialized healthcare. It also takes an important step toward evaluating OSA as a mechanism for the strong association between OSA and ADRD.