Outcomes of Sleep Disorders in Older Men

描述（由申请人提供）：拟定研究是一项为期5年的竞争性更新研究，老年男性睡眠障碍结局（MrOS睡眠研究）。MrOS睡眠研究旨在通过利用男性骨质疏松性骨折（MrOS）研究招募的既定队列，测试有关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MrOS参与者（>目标的100%）被纳入辅助MrOS睡眠研究。对睡眠的全面和客观评估（包括夜间家庭多导睡眠图（PSG），5天腕动记录和自我报告的睡眠质量测量），对突发心血管（CVD）事件的裁定，以及包括生物样本在内的其他测量方法被添加到MrOS母研究的扩展数据集中。在初始周期，我们确定睡眠呼吸障碍（SDB）和低氧血症是CVD、心律失常、死亡率和非脊柱骨折的重要独立预测因子。我们现在建议继续随访MrOS睡眠研究队列，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（目标1）。通过检测SDB/低氧血症与结局之间观察到的关系的几种潜在机制，还将在更新中扩展初步发现，包括i）可能阐明机制途径的生化决定因素; ii）肺功能和日间氧饱和度水平; iii）客观测量的睡眠持续时间（目标2）。我们进一步提出，通过对这些状况进行纵向评估，加强我们的几个与睡眠有关的横截面发现，这些横截面发现与年龄相关的状况包括虚弱、身体和认知功能有关（目标3）。最后，重复测量PSG和体动记录仪将使我们能够描述5年随访期间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（目标4）。这个难得的机会，继续随访超过3000名男性谁参加了最初的波的MrOS睡眠研究，并重新检查一个子集的队列谁已经贡献了如此丰富的数据，将提供新的见解之间的关系SDB和睡眠模式与随后的发病率和死亡率。公共卫生相关性：睡眠障碍非常常见，尤其是在老年人中。该研究的拟议更新，老年男性睡眠障碍的结局，将为睡眠呼吸障碍，低氧血症和睡眠模式（全面客观地测量）之间的关系提供新的见解，随后在社区居住的老年男性的大队列发病率和死亡率的风险。将探讨几种机制途径，除了扩展 随访，以便分析更具体的CVD结局和疾病特异性死亡率（而不是总体结局）。

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).