RELATING SLEEP DISORDERED BREATHING TO DAYTIME FUNCTION

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 日间过度嗜睡(EDS)是阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者最常见的主诉。这项研究的长期目标是研究生理压力、睡眠呼吸紊乱(SDB)、与之相关的睡眠碎片及其结果(日间嗜睡)之间的复杂关系。由于传统的碎片测量和嗜睡测量之间的相关性很差，将使用识别阻塞性呼吸事件的最佳可用技术和一种新的测量方法，在多个晚上对SDB进行评估，根据检测到的事件获得梗阻指数(OI)。这些将与EDS有关，使用多种测量方法进行量化，包括精神运动警戒任务、多重睡眠潜伏期测试和嗜睡的主观衡量标准。这些关系将在鼻腔持续正压(CPAP)监测治疗后疑似OSAHS的受试者和正常志愿者中进行评估。这项研究的具体目标如下：具体目标1：评估综合梗阻指数(OI)与睡眠障碍呼吸障碍严重程度不同的未经治疗的受试者的嗜睡程度的相关性。在子分析中，将评估具有不同特征的事件(例如，氧气减饱和、脑电和自主神经觉醒、上呼吸道阻力的变化)对EDS的相对贡献，以进一步细化OI，如果能够证明它们对EDS的指数贡献了额外的预测能力。具体目标2：测试梗阻指数在预测与CPAP治疗后SDB变化相关的嗜睡变化中的作用。具体目标3：通过实验引入SDB，通过次优的CPAP治疗，展示SDB(使用OI)对EDS的“剂量-反应”关系。具体目标4：使用梗阻指数预测短暂停用CPAP引起的SDB急性期后的嗜睡。定义这些关系不仅对我们理解这种疾病、诊断和治疗有意义，而且有助于更全面地理解睡眠和嗜睡之间的关系。在公共卫生方面，阻塞性睡眠呼吸暂停/低通气综合征影响到2-4%的美国成年人口。白天过度嗜睡是这些患者的主要问题。本研究有助于了解睡眠呼吸暂停患者的这些嗜睡症状。验证与嗜睡有关的睡眠呼吸紊乱的衡量标准将有助于改善阻塞性睡眠呼吸暂停的诊断和治疗。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Excessive daytime sleepiness (EDS) is the most common complaint of subjects suffering from obstructive sleep apnea hypopnea syndrome (OSAHS). The broad long-term objective of this research is to examine the complex relationship between the physiological stress, sleep disordered breathing (SDB), its associated sleep fragmentation, and its outcome (daytime sleepiness). Because correlations between conventional measures of fragmentation and measures of sleepiness have been poor, SDB will be assessed over multiple nights using the best available technology for identifying obstructive respiratory events and a novel measure, the obstructive index (OI) will be obtained from the events detected. These will be related to EDS, quantified using multiple measures including the psychomotor vigilance task, the Multiple Sleep Latency Test and subjective scales of sleepiness. These relationships will be evaluated in subjects with suspected OSAHS following monitored treatment with nasal Continuous Positive airway Pressure (CPAP) and in normal volunteers. The specific aims of the study are as follows: Specific Aim 1: Evaluate the correlation of an integrated Obstruction Index (OI) to sleepiness in untreated subjects with a range of severity of obstructive sleep disordered breathing. In a subanalysis, the relative contributions to EDS of events with different characteristics (e.g., O2 desaturation, EEG and autonomic arousal, changes in upper airway resistance) will be evaluated to further refine the OI if it can be shown they contribute additional predictive power of the index for EDS. Specific Aim 2: Test the utility of the Obstruction Index to predict changes in sleepiness associated with changes in SDB following treatment with CPAP. Specific Aim 3: Experimentally introduce SDB through suboptimal CPAP therapy to demonstrate a "dose-response" relationship of SDB (using the OI) to EDS. Specific Aim 4: Use the Obstruction Index to predict sleepiness following an acute period of SDB induced by a brief withdrawal of CPAP. Defining these relationships not only has implications for our understanding of this disease, its diagnosis and treatment, but also contributes to a more general understanding of the relationship between sleep and sleepiness. In terms of public health relevance, obstructive sleep apnea/hypopnea syndrome affects 2-4% of the adult U.S. population. Excessive daytime sleepiness is the primary problem in these patients. The present study contributes to understanding these symptoms of sleepiness in patients with sleep apnea. Validating a measure of sleep disordered breathing that relates to sleepiness will help improve the diagnosis and treatment of obstructive sleep apnea.