Race And CPAP Effectiveness
| Status: | Recruiting |
|---|---|
| Conditions: | Insomnia Sleep Studies, Pulmonary, Pulmonary |
| Therapuetic Areas: | Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 30 - 70 |
| Updated: | 1/13/2019 |
| Start Date: | January 5, 2015 |
| End Date: | June 30, 2019 |
| Contact: | Bharati Prasad, MD |
| Email: | bharati.prasad@va.gov |
Targeted Treatment of Obstructive Sleep Apnea to Reduce Cardiovascular Disparity
Obstructive sleep apnea (OSA) is a major public health problem in the U.S. and more than 35%
of Veterans are at high risk for OSA. OSA is associated with progression of hypertension, an
important health problem in Veterans. African Americans with OSA are at increased risk for
poorly controlled hypertension and its health consequences. Implementing a care plan to
increase the percentage of Veterans in whom blood pressure goals are achieved has been
prioritized by Veterans Administration hospitals. Recent studies show that hypertension
control can be improved with continuous positive airway pressure (CPAP) treatment of OSA. The
aim of this proposal is to examine and compare the effects of CPAP treatment on 24-hour
arterial blood pressure and central aortic blood pressure (measured non-invasively with a
cuff on the upper arm) in African American and other Veterans.
of Veterans are at high risk for OSA. OSA is associated with progression of hypertension, an
important health problem in Veterans. African Americans with OSA are at increased risk for
poorly controlled hypertension and its health consequences. Implementing a care plan to
increase the percentage of Veterans in whom blood pressure goals are achieved has been
prioritized by Veterans Administration hospitals. Recent studies show that hypertension
control can be improved with continuous positive airway pressure (CPAP) treatment of OSA. The
aim of this proposal is to examine and compare the effects of CPAP treatment on 24-hour
arterial blood pressure and central aortic blood pressure (measured non-invasively with a
cuff on the upper arm) in African American and other Veterans.
Obstructive Sleep Apnea (OSA) and hypertension are both common and severe problems in African
American individuals (as noted in the International Society on Hypertension in Blacks
consensus statement). CPAP treatment of OSA is effective in controlling hypertension in
patients with OSA, but has not been studied in African Americans, a high-risk population with
potentially large health gains. This is an area of significance because poorly controlled
hypertension leads to progression of cardiovascular disease (CVD) and morbidity in this
population. By identifying CPAP treatment-response and relevant moderators of this response
in African Americans with hypertension and OSA, targeted treatment of OSA can be implemented,
reducing the excess burden of CVD. The investigators will determine the relative magnitude of
hypertension response to CPAP treatment (ambulatory blood pressure and central aortic blood
pressure) in 220 African American and Veterans of other race(s) with hypertension and newly
diagnosed OSA (specific aim 1). The investigators will measure changes in pathogenic
biomarkers (urinary cumulative sympathetic nervous system activity and oxidative stress) that
are responsive to CPAP treatment in addition to hypertension assessments. Further, the
investigators will examine the role of excessive daytime sleepiness (EDS), a potentially
important moderator of treatment response, in these two patient populations (specific aim 2).
Finally, the investigators will adjust the outcomes assessment for the anticipated biological
heterogeneity among self-identified African Americans by measuring genetic ancestry
(exploratory aim). This award will provide the foundation for the goals of this research
program to reduce CVD disparity in diverse populations with targeted treatment of OSA.
American individuals (as noted in the International Society on Hypertension in Blacks
consensus statement). CPAP treatment of OSA is effective in controlling hypertension in
patients with OSA, but has not been studied in African Americans, a high-risk population with
potentially large health gains. This is an area of significance because poorly controlled
hypertension leads to progression of cardiovascular disease (CVD) and morbidity in this
population. By identifying CPAP treatment-response and relevant moderators of this response
in African Americans with hypertension and OSA, targeted treatment of OSA can be implemented,
reducing the excess burden of CVD. The investigators will determine the relative magnitude of
hypertension response to CPAP treatment (ambulatory blood pressure and central aortic blood
pressure) in 220 African American and Veterans of other race(s) with hypertension and newly
diagnosed OSA (specific aim 1). The investigators will measure changes in pathogenic
biomarkers (urinary cumulative sympathetic nervous system activity and oxidative stress) that
are responsive to CPAP treatment in addition to hypertension assessments. Further, the
investigators will examine the role of excessive daytime sleepiness (EDS), a potentially
important moderator of treatment response, in these two patient populations (specific aim 2).
Finally, the investigators will adjust the outcomes assessment for the anticipated biological
heterogeneity among self-identified African Americans by measuring genetic ancestry
(exploratory aim). This award will provide the foundation for the goals of this research
program to reduce CVD disparity in diverse populations with targeted treatment of OSA.
Inclusion Criteria:
- Self-identified African American and other Veterans (of self-identified race other
than African American)
- Age: 30-70 years
- Hypertension
- Apnea hypopnea index (AHI) 15/hour on home sleep apnea test
Exclusion Criteria:
- Past/current treatment of Obstructive Sleep Apnea or other primary sleep disorders
- Active uncontrolled medical conditions
- Shift work in past 6 months
- Current drug use
- Pregnancy
We found this trial at
1
site
Chicago, Illinois 60612
Principal Investigator: Bharati Prasad, MD
Phone: 312-569-6343
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