Document text
Principal Investigator: Isabella Soreca
Organization: VETERANS HEALTH ADMINISTRATION
Fiscal Year: 2024
Funding agency: Veterans Affairs
Obstructive Sleep Apnea (OSA) is a sleep disorder characterized by impaired patency of the
upper airway during sleep, resulting in numerous brief arousals from sleep and causing significant
disability, lost quality of life and premature mortality1. OSA affects approximately 4-6% of the
population nationwide 2, with higher rates among military Veterans 3, and an increase in
prevalence of nearly twofold between 2005 and 2014 among VA patients4. OSA has direct effects
on quality of life, health-care resources consumption and costs 5. Military Veterans who have been
diagnosed with OSA have greater risk of developing depressive and anxiety disorders 6 possibly
mediated by daytime consequences of poor sleep, such as fatigue and excessive daytime
sleepiness7. While effective at treating respiratory disturbances and providing symptoms
resolutions, treatment with Positive Airway Pressure (PAP) is not universally successful and a
non-negligible proportion of patients who are correctly using PAP do not experience symptomatic
relief from sleepiness and depression, suggesting that mechanisms beyond the respiratory
disturbances may be involved in the pathogenesis of symptoms leading to disability. A growing
body of literature in animal and human models suggests that the sleep and respiratory
disturbances commonly seen in OSA, namely sleep fragmentation, partial sleep deprivation,
intermittent hypoxia, can promote shifts in circadian rhythms ultimately leading to misalignment
between sleep-wake rhythms and the internal clock. Targeting the circadian disturbance with
chronotherapeutic interventions may improve symptoms that most affect daily functioning and
quality of life, ultimately preventing the downstream effects of OSA leading to disability.
Supplementary exposure to bright light has beneficial effects on sleep, daytime vigilance and
mood and it has been increasingly applied in a variety of sleep and neuropsychiatric conditions11
12. Our study is the first to use bright light therapy to improve sleep related functioning by reducing
the residual daytime symptoms most strongly linked to disability in patients with sleep apnea. We
will conduct a within-subjects crossover trial intervention to test the effects of BLT on and CPAP-
resistant symptoms of sleepiness and depression and sleep, sleep-related functional impairment
and quality of life in patients with OSA on CPAP therapy. We will also explore whether the
circadian phase shifting moderates the degree of changes in daytime symptoms and functional
impairment.
Terms: <Actinotherapy><Affect><Animal Model><Animal Models and Related Studies><Anxiety Disorders><Arousal><Biological Clocks><Biological Markers><Brain><Brain Nervous System><CPAP><CPAP Ventilation><Circadian Dysregulation><Circadian Rhythms><Consumption><Continuous Positive Airway Pressure><Cross-Over Studies><Cross-Over Trials><Crossover Studies><Crossover Trials><Cues><Depressive Syndromes><Depressive disorder><Diagnosis><Disease><Disorder><Drowsiness><Encephalon><Excessive Daytime Sleepiness><Excessive daytime somnolence><Exposure to><Fatigue><Functional impairment><Healthcare><Hour><Hypoxia><Hypoxic><Impairment><Intermediary Metabolism><Intervention><Intervention Strategies><Intervention Trial><Interventional trial><Knowledge><Lack of Energy><Legal patent><Light><Light Therapy><Link><Literature><Mediating><Melatonin><Mental Depression><Metabolic Processes><Metabolism><Moods><Nyctohemeral Rhythm><Obstructive Sleep Apnea><Organism><Oxygen Deficiency><Participant><Patents><Pathogenesis><Patients><Peripheral><Phase><Photoradiation><Photoradiation Therapy><Phototherapy><Pilot Projects><Placebos><Population><Premature Mortality><Prevalence><QOL><Quality of life><Research Resources><Residual><Residual state><Resistance><Resolution><Resources><Risk><Sham Treatment><Sleep><Sleep Apnea><Sleep Apnea Syndromes><Sleep Deprivation><Sleep Disorders><Sleep Fragmentations><Sleep Hypopnea><Sleep Wake Cycle><Sleep disturbances><Sleep-Disordered Breathing><Somnolence><Symptoms><Syndrome, Sleep Apnea, Obstructive><Testing><Time><Twenty-Four Hour Rhythm><Veterans><Wakefulness><aberrant sleep><active method><active technique><active treatment><affective disturbance><alertness><associated symptom><bio-markers><biologic marker><biomarker><body clock><circadian><circadian abnormality><circadian clock><circadian disruption><circadian disturbance><circadian dysfunction><circadian impairment><circadian pacemaker><circadian process><co-morbid symptom><co-occuring symptom><comorbid symptom><concurrent symptom><cooccuring symptom><cost><daily biorhythm><daily functioning><deficient sleep><depression><disability><disrupted sleep><disturbance in affect><disturbed sleep><experience><feasibility testing><health care><human model><impaired sleep><improve symptom><improved><improvement on sleep><inadequate sleep><insufficient sleep><interest><internal clock><interventional strategy><irregular sleep><light intervention><light treatment><living system><military veteran><model of animal><model of human><mood alteration><mood and affect disturbance><mood disturbance><mood dysfunction><neuropsychiatric><neuropsychiatry><pilot study><poor sleep><positive airway pressure><prevent><preventing><resistant><resolutions><respiratory><response><response to therapy><response to treatment><sham therapy><sleep debt><sleep deficiency><sleep deficit><sleep diseases><sleep disruption><sleep dysfunction><sleep dysregulation><sleep illness><sleep improvement><sleep insufficiency><sleep loss><sleep problem><sleep-related breathing disorder><sleepiness><symptom association><symptom comorbidity><symptom improvement><symptomatic improvement><therapeutic response><therapy response><time interval><treatment response><treatment responsiveness><veteran population><vigilance>