title: The Determining Risk of Vascular Events by Apnea Monitoring (DREAM) study: design, rationale, and methods.
abstract: OBJECTIVE
  The goal of the Determining Risk of Vascular Events by Apnea Monitoring (DREAM) study is to develop a prognostic model for cardiovascular outcomes, based on physiologic variables-related to breathing, sleep architecture, and oxygenation-measured during polysomnography in US veterans.
  
  
  METHODS
  The DREAM study is a multi-site, retrospective observational cohort study conducted at three Veterans Affairs (VA) centers (West Haven, CT; Indianapolis, IN; Cleveland, OH). Veterans undergoing polysomnography between January 1, 2000 and December 31, 2004 were included based on referral for evaluation of sleep-disordered breathing, documented history and physical prior to sleep testing, and ≥2-h sleep monitoring. Demographic, anthropomorphic, medical, medication, and social history factors were recorded. Measures to determine sleep apnea, sleep architecture, and oxygenation were recorded from polysomnography. VA Patient Treatment File, VA-Medicare Data, Vista Computerized Patient Record System, and VA Vital Status File were reviewed on dates subsequent to polysomnography, ranging from 0.06 to 8.8 years (5.5 ± 1.3 years; mean ± SD).
  
  
  RESULTS
  The study population includes 1840 predominantly male, middle-aged veterans. As designed, the main primary outcome is the composite endpoint of acute coronary syndrome, stroke, transient ischemic attack, or death. Secondary outcomes include incidents of neoplasm, congestive heart failure, cardiac arrhythmia, diabetes, depression, and post-traumatic stress disorder. Laboratory outcomes include measures of glycemic control, cholesterol, and kidney function. (Actual results are pending.)
  
  
  CONCLUSIONS
  This manuscript provides the rationale for the inclusion of veterans in a study to determine the association between physiologic sleep measures and cardiovascular outcomes and specifically the development of a corresponding outcome-based prognostic model.
authors.affiliation: Department of Neurology, Yale University, New Haven, CT, USA.|Department of Neurology, Connecticut Veterans Affairs Health System, West Haven, CT, USA.
authors.forename: Brian B
authors.initials: BB
authors.lastname: Koo
authors.affiliation: Department of Pulmonary, Critical Care, and Sleep Medicine, Yale University, New Haven, CT, USA.|Department of Pulmonary, Critical Care, and Sleep Medicine, Connecticut Veterans Affairs Health System, West Haven, CT, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Won
authors.affiliation: Department of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Bernardo J
authors.initials: BJ
authors.lastname: Selim
authors.affiliation: Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Qin
authors.affiliation: Division of Acute Care/Health Systems, Yale School of Nursing, New Haven, CT, USA.
authors.forename: Sangchoon
authors.initials: S
authors.lastname: Jeon
authors.affiliation: Division of Acute Care/Health Systems, Yale School of Nursing, New Haven, CT, USA.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Redeker
authors.affiliation: Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.|VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.|Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.|Regenstrief Institute, Indianapolis, IN, USA.|Department of Medicine, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
authors.affiliation: Department of Pulmonary, Critical Care, and Sleep Medicine, Case Western Reserve University, Cleveland, OH, USA.|Department of Pulmonary, Critical Care, and Sleep Medicine, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, USA.
authors.forename: Kingman P
authors.initials: KP
authors.lastname: Strohl
authors.affiliation: Department of Internal Medicine, Yale University, New Haven, CT, USA.|Clinical Epidemiology Research Center (CERC), Connecticut Veterans Affairs Health System, West Haven, CT, USA.
authors.forename: John
authors.initials: J
authors.lastname: Concato
authors.affiliation: Department of Pulmonary, Critical Care, and Sleep Medicine, Yale University, New Haven, CT, USA.|Department of Pulmonary, Critical Care, and Sleep Medicine, Connecticut Veterans Affairs Health System, West Haven, CT, USA.
authors.forename: Andrey V
authors.initials: AV
authors.lastname: Zinchuk
authors.affiliation: Department of Pulmonary, Critical Care, and Sleep Medicine, Yale University, New Haven, CT, USA. henry.yaggi@yale.edu.|Department of Pulmonary, Critical Care, and Sleep Medicine, Connecticut Veterans Affairs Health System, West Haven, CT, USA. henry.yaggi@yale.edu.|, 300 Cedar Street, New Haven, CT, 06443, USA. henry.yaggi@yale.edu.
authors.forename: Henry K
authors.initials: HK
authors.lastname: Yaggi
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012189:Retrospective Studies; D018570:Risk Assessment; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000401:mortality; D020521:Stroke / Q000175:diagnosis* / Q000401:mortality; D014481:United States; D014728:Veterans
keywords: Cardiovascular; Epidemiology; OSA; Sleep apnea; Veterans