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出境医 / 临床实验 / Sleep Disordered Breathing and Cardiopulmonary Disease in Peruvian Highlanders
Sleep Disordered Breathing and Cardiopulmonary Disease in Peruvian Highlanders
Study Description
Brief Summary:
Overall objective: To understand the feasibility of performing a randomized trial using a simple, minimally-invasive postural therapy approach to improve sleep disordered breathing (SDB).
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Sleep Disordered Breathing Sleep Apnea | Device: Inclined Sleep | Not Applicable |
Detailed Description:
Specific Aims:
- To examine the relative efficacy of postural therapy (a 15-degree wedge mattress) on measures of chronic cardiometabolic stress in high altitude residents.
- To determine the tolerability of postural therapy.
Primary outcomes, at 4 and 8 weeks:
- Mean nocturnal oxyhemoglobin saturation (SPO2)
- Apnea-hypopnea index (AHI).
Secondary outcomes
- Markers of hypoxemia exposure: the investigators will evaluate for differences in average hemoglobin and erythropoietin concentrations between intervention groups using t-tests or Wilcoxon rank sum tests, as considered appropriate. If transformations are necessary, the investigators will use Box-Cox power transform to identify the best transformation for the investigators' data.
- Markers of metabolic dysfunction: the investigators will evaluate for differences in average Glycated hemoglobin test (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), total cholesterol, low-density lipoprotein cholesterol (LDL), High-density lipoprotein cholesterol (HDL), triglycerides, SVEGF-R1 , and soluble Vascular Endothelial Growth Factor (SVEGF-1) concentrations between intervention groups using t-tests or Wilcoxon rank sum tests, as appropriate. If transformations are necessary, the investigators will use Box-Cox power transform to identify the best transformation for the investigators' data.
- Markers of cardiometabolic stress: the investigators will evaluate for differences in average systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse, and % change in endothelial function (reactive hyperemia index) as assessed by brachial artery reactivity testing (BART) between intervention groups using t-tests or Wilcoxon rank sum tests, as considered appropriate.
- Adherence (the average number of nights during the 8-week period that participants slept on the wedge mattress),
Study Design
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 54 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | Single (Outcomes Assessor) |
| Masking Description: | Subjects will undergo sleep study in subjects' randomized sleep posture. Randomization will be recorded separately from sleep study recordings. These recordings will be reviewed by trained sleep study technicians who will be blinded to randomization. Blood samples will also be assayed for markers of glucose control. |
| Primary Purpose: | Treatment |
| Official Title: | Sleep Disordered Breathing and Cardiopulmonary Disease in Peruvian Highlanders |
| Actual Study Start Date : | September 29, 2019 |
| Actual Primary Completion Date : | March 15, 2020 |
| Actual Study Completion Date : | March 15, 2020 |
Arms and Interventions
| Arm | Intervention/treatment |
|---|---|
|
Experimental: Inclined Sleep
Inclined mattress at 15 degrees
|
Device: Inclined Sleep
Study participants randomized to the interventional arm will be instructed to sleep on inclined wedge mattress.
Other Names:
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No Intervention: Flat Sleep
Plane mattress
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Outcome Measures
Primary Outcome Measures :
- Change in Respiratory Disturbance Index (RDI) [ Time Frame: Baseline, 4 weeks, 8 weeks ]
The investigators will measure a change in Respiratory Disturbance Index (RDI) defined as an oxygen desaturation of at least 4 percent associated with autonomic signs of arousal. Specifically, autonomic arousals are defined as concurrent rises in heart rate and attenuation of arterial tonometry.
Normal < 5 percent 5 percent < Mild < 15 percent 15 percent < Moderate < 30 percent Severe > 30 percent
- Change in Mean oxyhemoglobin saturation (percent) during sleep [ Time Frame: Baseline, 4 weeks, 8 weeks ]The investigators will measure mean oxyhemoglobin saturation (%SaO2) during sleep as assessed by WatchPAT home sleep study at baseline and week 8.
Secondary Outcome Measures :
- Tolerability of postural therapy as assessed by adherence monitor [ Time Frame: 2, 4, 6 and 8 weeks ]Adherence monitor will measure sleep over the set time points and tolerability is defined as a recorded time on the wedge for a minimum of 5 hours.
- Change in average plasma hemoglobin concentration (g/dL) [ Time Frame: Baseline, 8 weeks ]
- Change in average Glycated hemoglobin test (HbA1c) [ Time Frame: Baseline, 8 weeks ]This will measure percentage (%) of HbA1c in the blood.
- Change in serum erythropoietin (EPO) concentration [ Time Frame: Baseline, 8 weeks ]The concentration of EPO in the sample is expressed in International Units per litre (U/L) and is determined by calibration against a reference standard.
- Change in soluble Vascular Endothelial Growth Factor (SVEGF-1) concentrations [ Time Frame: Baseline, 8 weeks ]Plasma levels of SVEGF-1 (pg/mL)
- Change in homeostatic model assessment of insulin resistance (HOMA-IR) [ Time Frame: Baseline, 8 weeks ]Units of measurement is mass units.
- Change in total plasma cholesterol level (mg/dL) [ Time Frame: Baseline, 8 weeks ]
- Change in plasma low-density lipoprotein (LDL) cholesterol level (mg/dL) [ Time Frame: Baseline, 8 weeks ]
- Change in plasma high-density lipoprotein (HDL) cholesterol level (mg/dL) [ Time Frame: Baseline, 8 weeks ]
- Change in plasma triglyceride concentration (mg/dL) [ Time Frame: Baseline, 8 weeks ]
- Change in Vascular endothelial growth factor receptor 1 (SVEGF-R1) concentration [ Time Frame: Baseline, 8 weeks ]Units of measurement pg/mL
- Change in mean blood pressure (mmHg) [ Time Frame: Baseline, 8 weeks ]
- Change in Brachial Artery Reactivity Testing (BART) assessment [ Time Frame: Baseline, 8 weeks ]
Assessed by endothelial function using high-frequency ultrasound visualized brachial artery reactivity testing. Endothelial function is characterized by flow-mediated vasodilation of the brachial artery, which is measured by comparing the brachial artery diameter at rest to the diameter after increased forearm blood flow (reactive hyperemia).
Unit of measurement is mass units.
Eligibility Criteria
| Ages Eligible for Study: | 40 Years to 80 Years (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | Yes |
Criteria
Inclusion criteria
- Age 40-80 years
- Daytime oxyhemoglobin saturation ≥80%, seated.
- Body mass index ≥25 kg/m2
- Hemoglobin >13 g/dL in women and >15 g/dL in men
- Ability to provide informed consent
- Sleeps at home in same bed every night
- Expected stable residence for at least 6 months
- Sleeps with two pillows or fewer
- Demonstrate acute improvement in SDB severity with postural therapy
- Able to sleep ≥5 hours at an incline for all three nights during the run-in period
Exclusion criteria
- Works the night-shift or a rotating shift
- Has an indication or preference for sleeping upright, semi-recumbent or at an incline
- Chronic insomnia or a non-respiratory sleep disorder
- Physician-established diagnosis of diabetes, lung, cardiovascular, liver, or chronic kidney disease
- Using home oxygen therapy or other respiratory assistive device [e.g., continuous positive airway pressure (CPAP), nebulizer]
- Self-reported severe gastrointestinal reflux
- Self-report of occult blood or history of gastrointestinal bleeding in the past 3 months
- Pregnancy
- Unable to sleep ≥5 hours at an incline for all three nights during the run-in period
The following exclusion criteria apply only for those undergoing spirometry for safety reasons. Participants with any one of these criteria, will be excluded from spirometry but can still participate in the rest of the screening phase:
- Surgery of the heart, chest, lungs in the past 3 months (participants will be revisited at a later period)
- Heart attack in the past 3 months (participants will be revisited at a later period)
- History of eye surgery
- History of abdominal surgery in the past 3 months.
Contacts and Locations
Locations
| Peru | |
| Prisma Org | |
| Puno, Peru | |
Sponsors and Collaborators
Johns Hopkins University
National Institutes of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Investigators
| Principal Investigator: | William Checkley | Johns Hopkins University |
| Tracking Information | |||||
|---|---|---|---|---|---|
| First Submitted Date ICMJE | April 23, 2019 | ||||
| First Posted Date ICMJE | April 25, 2019 | ||||
| Last Update Posted Date | November 6, 2020 | ||||
| Actual Study Start Date ICMJE | September 29, 2019 | ||||
| Actual Primary Completion Date | March 15, 2020 (Final data collection date for primary outcome measure) | ||||
| Current Primary Outcome Measures ICMJE |
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| Original Primary Outcome Measures ICMJE | Same as current | ||||
| Change History | |||||
| Current Secondary Outcome Measures ICMJE |
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| Original Secondary Outcome Measures ICMJE | Same as current | ||||
| Current Other Pre-specified Outcome Measures | Not Provided | ||||
| Original Other Pre-specified Outcome Measures | Not Provided | ||||
| Descriptive Information | |||||
| Brief Title ICMJE | Sleep Disordered Breathing and Cardiopulmonary Disease in Peruvian Highlanders | ||||
| Official Title ICMJE | Sleep Disordered Breathing and Cardiopulmonary Disease in Peruvian Highlanders | ||||
| Brief Summary | Overall objective: To understand the feasibility of performing a randomized trial using a simple, minimally-invasive postural therapy approach to improve sleep disordered breathing (SDB). | ||||
| Detailed Description |
Specific Aims:
Primary outcomes, at 4 and 8 weeks:
Secondary outcomes
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| Study Type ICMJE | Interventional | ||||
| Study Phase ICMJE | Not Applicable | ||||
| Study Design ICMJE | Allocation: Randomized Intervention Model: Parallel Assignment Masking: Single (Outcomes Assessor) Masking Description: Subjects will undergo sleep study in subjects' randomized sleep posture. Randomization will be recorded separately from sleep study recordings. These recordings will be reviewed by trained sleep study technicians who will be blinded to randomization. Blood samples will also be assayed for markers of glucose control. Primary Purpose: Treatment
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| Condition ICMJE |
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| Intervention ICMJE | Device: Inclined Sleep
Study participants randomized to the interventional arm will be instructed to sleep on inclined wedge mattress.
Other Names:
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| Study Arms ICMJE |
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| Publications * | Not Provided | ||||
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* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline. |
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| Recruitment Information | |||||
| Recruitment Status ICMJE | Completed | ||||
| Actual Enrollment ICMJE |
54 | ||||
| Original Estimated Enrollment ICMJE |
120 | ||||
| Actual Study Completion Date ICMJE | March 15, 2020 | ||||
| Actual Primary Completion Date | March 15, 2020 (Final data collection date for primary outcome measure) | ||||
| Eligibility Criteria ICMJE |
Inclusion criteria
Exclusion criteria
The following exclusion criteria apply only for those undergoing spirometry for safety reasons. Participants with any one of these criteria, will be excluded from spirometry but can still participate in the rest of the screening phase:
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| Sex/Gender ICMJE |
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| Ages ICMJE | 40 Years to 80 Years (Adult, Older Adult) | ||||
| Accepts Healthy Volunteers ICMJE | Yes | ||||
| Contacts ICMJE | Contact information is only displayed when the study is recruiting subjects | ||||
| Listed Location Countries ICMJE | Peru | ||||
| Removed Location Countries | |||||
| Administrative Information | |||||
| NCT Number ICMJE | NCT03927547 | ||||
| Other Study ID Numbers ICMJE | IRB00170895 R34HL135360 ( U.S. NIH Grant/Contract ) |
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| Has Data Monitoring Committee | Yes | ||||
| U.S. FDA-regulated Product |
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| IPD Sharing Statement ICMJE |
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| Responsible Party | Johns Hopkins University | ||||
| Study Sponsor ICMJE | Johns Hopkins University | ||||
| Collaborators ICMJE |
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| Investigators ICMJE |
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| PRS Account | Johns Hopkins University | ||||
| Verification Date | March 2020 | ||||
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ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP |
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