Phenotyping Mechanistic Pathways for Adverse Health Outcomes in Sleep Apnea

Brigham and Women's Hospital209 enrolled

Overview

Obstructive sleep apnea (OSA) is a highly prevalent disorder with adverse neurocognitive and cardio-metabolic outcomes. Continuous positive airway pressure (CPAP) is the gold standard therapeutic option to treat airway obstructions during sleep and thus, prevent its adverse cardiovascular and neurocognitive outcomes. Previous clinical trials, however, have largely failed to show a consistent impact of CPAP on these health outcomes. One of the main limitations of these trials may be the inadequate characterization of OSA and its acute physiological consequences. By characterizing OSA based on the "apnea-hypopnea index (AHI)", there is a potential risk of negative results. In this trial, the investigators intend to tackle this issue, by better characterization of OSA-related physiological consequences during sleep using physiologically driven metrics to capture the burden of OSA-related hypoxemia ("hypoxic burden"), autonomic response ("heart rate burden"), and sleep fragmentation ("arousal burden").

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

209

Conditions

Sleep Apnea

Interventions

Eligibility

Sex: ALLMin age: 21 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion criteria: * Adults aged 21-80 years. * Participants with a previous diagnosis of moderate to severe obstructive sleep will be eligible to enroll and attend the baseline study. Patients with a total apnea-hypopnea index greater than 15 events/hr on the baseline study will be eligible for further participation. Exclusion criteria: * Current treatment for obstructive sleep apnea (including CPAP, oral appliances, supplemental oxygen). Patients must be untreated prior to the baseline visit. * Use of medications that might depress respiration (including opioids, barbiturates, benzodiazepines, and Z drugs, including zolpidem, zopiclone, eszopiclone, and zaleplon). * Active use of non-prescription opioids (e.g., cocaine, methamphetamine) * Uncontrolled medical problem or major organ system disease, which, in the opinion of the investigators (PI and Co-Is), would interfere with the evaluation of the subject (e.g., uncontrolled hypertension, unstable coronary heart disease, etc.). * History of congestive heart failure, renal insufficiency, systemic neurological condition that could affect respiration. * Sleep disordered breathing or respiratory disorders other than obstructive sleep apnea: * central sleep apnea (\>50% of respiratory events scored as central), * chronic hypoventilation/hypoxemia (awake SaO2 \< 92% by oximetry) due to chronic obstructive pulmonary disease or other respiratory conditions. * Other sleep disorders: periodic limb movements (periodic limb movement arousal index \> 10/hr), narcolepsy, or parasomnias. * Patients unable or unwilling to use CPAP. * Insomnia or insufficient sleep (self-reported inability to sleep \>6 hrs night). * Pregnancy (women)

Outcomes

Primary Outcomes

Change from baseline flow-mediated vasodilation at 12 weeks

Flow mediated vasodilation is studied using high resolution ultrasound of the artery.

Time frame: 12 weeks

Change from baseline 24-hour mean systolic blood pressure at 12 weeks

Mean systolic blood pressure over a 24-hour period is measured using an ambulatory blood pressure monitor.

Time frame: 12 weeks

Change from baseline Epworth Sleepiness Scale (ESS) at 12 weeks

Self-reported sleepiness measured using the Epworth Sleepiness Scale (units on a scale). Values range from 0-24; higher values indicate greater sleepiness.

Time frame: 12 weeks

Secondary Outcomes

Change from baseline F2-Isoprostane/Creatinine Ratio at 12 weeks

F2-Isoprostane/Creatinine Ratio, a measure of oxidative stress, is calculated from urine sample.

Time frame: 12 weeks

Change from baseline Albumin/Creatinine Ratio at 12 weeks

Urinary Albumin/Creatinine Ratio is calculated from urine samples.

Time frame: 12 weeks

Change from baseline Albumin without Creatinine at 12 weeks

Urinary Albumin is calculated from urine samples.

Time frame: 12 weeks

Change from baseline Oxidized low-density lipoprotein (LDL) at 12 weeks

Oxidized low-density lipoprotein measurements are calculated through fasting phlebotomy.

Time frame: 12 weeks

Change from baseline N-terminal pro b-type natriuretic peptide (NT-proBNP) at 12 weeks

N-terminal pro b-type natriuretic peptide (NT-proBNP) measurements are calculated through fasting phlebotomy.

Time frame: 12 weeks

Change from baseline Hemoglobin A1c (HbA1c) at 12 weeks

Hemoglobin A1c (HbA1c) measurements are calculated through fasting phlebotomy.

Time frame: 12 weeks

Change from baseline Plasminogen Activator Inhibitor-1 at 12 weeks

Plasminogen activator inhibitor type 1 (PAI-1) measurements are calculated through fasting phlebotomy.

Time frame: 12 weeks

Change from baseline Fibrinogen Antigen at 12 weeks

Fibrinogen Antigen measurements are calculated through fasting phlebotomy. High values indicate inflammation and increased risk of atherosclerosis.

Time frame: 12 weeks

Change from baseline Glucose at 12 weeks

Blood glucose measurements are calculated through fasting phlebotomy

Time frame: 12 weeks

Change from baseline high sensitivity C-Reactive Protein (hs-CRP) at 12 weeks

C-reactive protein measurements are calculated from blood samples collected through fasting phlebotomy.

Time frame: 12 weeks

Change from baseline Interleukin-6 (IL-6) at 12 weeks

IL-6 is calculated from blood samples collected through fasting phlebotomy

Time frame: 12 weeks

Change from baseline Creatinine at 12 weeks

Creatinine is calculated from blood samples collected through fasting phlebotomy

Time frame: 12 weeks

Change from baseline Cystanin C with eGFR at 12 weeks

Cystanin C with eGFR is calculated from blood samples collected through fasting phlebotomy

Time frame: 12 weeks

Change from baseline lipid panel at 12 weeks

Lipid panel measurements are calculated from blood samples collected through fasting phlebotomy.

Time frame: 12 weeks

Change from baseline 24-hour mean diastolic blood pressure at 12 weeks

Mean diastolic blood pressure over a 24-hour period is measured using an ambulatory blood pressure monitor.

Time frame: 12 weeks

Change from baseline 24-hour mean blood pressure at 12 weeks

Mean arterial blood pressure over a 24-hour period is measured using an ambulatory blood pressure monitor.

Time frame: 12 weeks

Change from baseline nocturnal mean systolic blood pressure at 12 weeks

Mean systolic blood pressure during sleep is measured using an ambulatory blood pressure monitor.

Time frame: 12 weeks

Change from baseline nocturnal mean diastolic blood pressure at 12 weeks

Mean diastolic blood pressure during sleep is measured using an ambulatory blood pressure monitor.

Time frame: 12 weeks

Change from baseline nocturnal mean blood pressure at 12 weeks

Mean arterial blood pressure during sleep is measured using an ambulatory blood pressure monitor.

Time frame: 12 weeks

Change from baseline Psychomotor Vigilance Task reaction time at 12 weeks

3-minute Psychomotor Vigilance Tasks will be done to quantify the speed with which subjects respond to a visual stimulus.

Time frame: 12 weeks

Change from baseline Psychomotor Vigilance Task lapses per test at 12 weeks

3-minute Psychomotor Vigilance Tasks will be done to quantify the speed with which subjects respond to a visual stimulus.

Time frame: 12 weeks

Change from baseline Functional Outcome of Sleep Questionnaire (FOSQ) at 12 weeks

This test will be used to assess the impact of excessive sleepiness on functional outcomes relevant to daily behaviors and sleep-related quality of life.

Time frame: 12 weeks

Phenotyping Mechanistic Pathways for Adverse Health Outcomes in Sleep Apnea

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes