Race And CPAP Effectiveness
Condition: Sleep Apnea Syndromes
MeSH terms: Sleep Apnea Syndromes
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Continuous positive airway pressure
Intervention type(s): Device
Intervention description(s): A portable ventilatory assist device, which is the standard first line treatment of sleep apnea.
Other intervention name(s): CPAP
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: CPAP treatment; hypertension