Nocturnal Rostral Fluid Shifts In Stroke Patients With Sleep Apnea

 描述(申请人提供)：中风是美国成年人残疾的主要原因，也是第四大死亡原因，在少数族裔人群中发病率较高。超过一半的缺血性中风患者患有睡眠呼吸暂停，这是一种非常常见和重要的预测不良中风结果的指标，包括死亡和身体残疾。这种高患病率的原因尚不清楚，而睡眠呼吸暂停的治疗在中风人群中是一个特别的挑战，因为对现有治疗的依从性很差。更好地了解中风后睡眠呼吸暂停的病理生理学可能会为治疗提供新的、更耐受的靶点。白天在腿部积聚的液体在晚上可能会重新分配到更多的吻部隔室。通过咽部狭窄和增加呼吸道塌陷性，这些液体的转移已被证明在一些人群中导致睡眠呼吸暂停。在活动能力受损和医源性液体超载很常见的中风患者中，尚未对夜间喙液体移位进行研究。该项目的母公司研究，Corpus Christi睡眠呼吸暂停(BASIC)项目的脑攻击监测(BASIC)项目，是一项正在进行的基于人群的中风监测研究，确定了德克萨斯州努塞斯县的所有中风病例。该项目在美国最大的少数族裔拉美裔和非拉美裔白人中关于中风的研究取得了许多重要发现，其相关研究(基础睡眠呼吸暂停项目(BASIC-S))开始为中风后睡眠呼吸暂停的流行病学提供有价值的新见解。Basic将继续识别Nueces县的所有缺血性中风，并将提供详细的基线信息，而Basic-S将在研究期间的部分时间内通过经过验证的便携式心肺测试提供睡眠呼吸暂停测试。在目前的应用中，我们在基础项目的基础上增加了辅助研究，包括急性卒中期间的颈围和腿围和生物阻抗谱测量。我们建议将这些措施与基线卒中后睡眠呼吸暂停评估和卒中结局联系起来。鉴于招聘目前正在进行中，将于2018年5月31日停止，因此尽快开始新的评估至关重要，以最大限度地扩大样本数量和力量，以实现给定的研究目标。这项辅助研究将使我们能够以成本控制的方式回答关于两族社区中风后睡眠呼吸暂停的病理生理学的重要、新颖的问题，因为我们将使用现有的基础设施来识别病例和评估睡眠呼吸暂停。对夜间鸡嘴液体变化的识别将为简单、可耐受的治疗提供目标，以改善一种重要而常见的疾病--睡眠呼吸暂停，这是一种毁灭性的疾病--中风，在美国少数民族人口中，中风是规模最大、增长最快的。

 DESCRIPTION (provided by applicant): Stroke, the leading cause of adult disability in the US and the fourth leading cause of death, has a higher incidence in minority populations. More than half of ischemic stroke patients have sleep apnea, a very common and important predictor of poor stroke outcomes including death and physical disability. Reasons for this high prevalence are poorly understood, and treatment of sleep apnea is a particular challenge in the stroke population due to poor compliance with existing treatments. A better understanding of the pathophysiology of post-stroke sleep apnea could yield new, more tolerable targets for treatment. Daytime fluid pooling in the legs may be redistributed at night into more rostral compartments. Through pharyngeal narrowing and increased airway collapsibility, these fluid shifts have been shown to contribute to sleep apnea in some populations. Nocturnal rostral fluid shifts have not been investigated in stroke patients, where impaired mobility and iatrogenic fluid overload are common. The parent study for this project, the Brain Attack Surveillance in Corpus Christi Sleep Apnea (BASIC) project, is an ongoing population-based stroke surveillance study that identifies all stroke cases in Nueces County, Texas. This project has made many important discoveries about stroke in Hispanics, the largest minority group in the US, and non-Hispanic whites, and its related study (BASIC-Sleep Apnea Project (BASIC-S)) is beginning to yield valuable new insights into the epidemiology of post-stroke sleep apnea. BASIC will continue to identify all ischemic strokes in Nueces County and will provide detailed baseline information while BASIC-S will provide sleep apnea testing with a validated portable cardiopulmonary test for part of the study period. In the current application, we add ancillary studies to the BASIC project including neck and leg circumference and bioimpedance spectroscopy measurements in the acute stroke period. We propose to relate these measures to the baseline post-stroke sleep apnea assessments and stroke outcomes. Given that recruitment is currently underway and will cease May 31, 2018, it is critical to begin the new assessments as soon as possible to maximize the sample size and power for the given study objectives. This ancillary study will allow us to answer important, novel questions about the pathophysiology of sleep apnea post-stroke within a bi-ethnic community in a cost-containing fashion, as we will use existing infrastructure for case identification and sleep apnea assessment. Recognition of nocturnal rostral fluid shifts will suggest targets for simple, tolerable treatments to ameliorate an important and common disorder, sleep apnea, in a devastating disease, stroke, in the largest and fastest growing US minority population.