National Sleep Research Resource (NSRR): Cleveland Family Study (CFS)

The Cleveland Family Study (CFS) is a family-based study of sleep apnea, consisting of 2,284 individuals (46% African American) from 361 families studied on up to 4 occasions over a period of 16 years. The study began in 1990 with the initial aims of quantifying the familial aggregation of sleep apnea. National Institutes of Health (NIH) renewals provided expansion of the original cohort, including increased minority recruitment, and longitudinal follow-up, with the last exam occurring in February 2006. The CFS was designed to provide fundamental epidemiological data on risk factors for sleep disordered breathing (SDB). The sample was selected by identifying affected probands who had laboratory diagnosed obstructive sleep apnea. All first-degree relatives, spouses and available second-degree relatives of affected probands were studied. In addition, during the first 5 study years, neighborhood control families were identified through a neighborhood proband, and his/her spouses and first-degree relatives. Each exam, occurring at approximately 4-year intervals, included new enrollment as well as follow up exams for previously enrolled subjects. For the first three visits, data, including an overnight sleep study, were collected in participants' homes while the last visit occurred in a general clinical research center (GCRC). Phenotypic characterization of the entire cohort included overnight sleep apnea studies, blood pressure, spirometry, anthropometry and questionnaires. Currently, data of 710 individuals are available for use through BioData Catalyst (with genotype data available through dbGaP).The National Sleep Research Resource (NSRR) is a NIH-supported sleep data repository that offers free access to large collections of de-identified physiological signals and related clinical data from a large range of cohort studies, clinical trials and other data sources from children and adults, including healthy individuals from the community and individuals with known sleep or other health disorders. The goals of NSRR are to facilitate rigorous research that requires access to large or more diverse data sets, including raw physiological signals, to promote a better understanding of risk factors for sleep and circadian disorders and/or the impact of sleep disturbances on health-related outcomes. Data from over 15 data sources and more than 40,000 individual sleep studies, many linked to dozens if not hundreds of clinical data elements, are available (as of Feb. 2022). Query tools are available to identify variables of interest, and their meta-data and provenance.]]>
Inclusion CriteriaCases were probands with laboratory-diagnosed obstructive sleep apnea (AHI > 15 or treated with CPAP). All cases and their first degree and selective second degree relatives and spouses comprised the "case family" sample.
Control probands were selected as a neighbor of the case proband. Their first degree relatives and spouses comprised the control family sample.
Exclusion Criteriainability to provide informed consentno family relationship with cases or controlsknown congenital disorder associated with sleep apnea for cases.]]>
The Cleveland Family Study contains longitudinal data (multiple observations per person). Exam visits occurred as many as 4 times over a 15 year time interval. New participants joined the study during subsequent waves of data collection, and thus data are available from one to four exams per participant. The variable named VISIT denotes the type of visit. There are labels VISIT #1 (1990-2001), VISIT #2 (1996-2001), VISIT #3 (1999-2001), and VISIT #5 (2001-2005), but not VISIT #4. These visits did not occur in "waves", and instead they reflect which visit number was recorded. Recruitment was rolling, and thus some individuals had a first visit (VISIT = 1) while others had a second or third visit (VISIT = 2 or 3).
The first 3 visits occurred in participants' homes. Individuals who participated in visits 2 and 3 included many participants who were available for examination from a prior visit. There were also additional family members and new minority families recruited later and recorded as visits 1 or 5, depending on type of data collected. Visit 5 occurred in a dedicated clinical research unit (GCRU). This visit targeted minority families and families in whom a prior microsatellite exam had been conducted (selected for genetic informativity). Data collection for visit 5 was more comprehensive; it generally included prior measurements as well as more detailed biochemical data, ECGs, endothelial function, and sleep staging data. Thus, the data from VISIT = 5 accounts for the most recent visit for data collected on individuals in the Cleveland Family Study and represents the most complete data collection but includes data of only 710 participants.]]>

克利夫兰家族研究（Cleveland Family Study, CFS）是一项基于家系的睡眠呼吸暂停研究，共纳入来自361个家系的2284名受试者（其中46%为非裔美国人），在16年间开展了至多4次随访调研。该研究于1990年启动，最初旨在量化睡眠呼吸暂停的家族聚集性。美国国立卫生研究院（National Institutes of Health, NIH）的多次续资助推了原始队列的扩编，包括增加少数族裔招募比例与纵向随访工作，最后一次随访于2006年2月完成。CFS旨在为睡眠呼吸障碍（sleep disordered breathing, SDB）的风险因素提供基础流行病学数据。

研究样本通过招募经实验室确诊的阻塞性睡眠呼吸暂停先证者确定，所有先证者的一级亲属、配偶及可获取的二级亲属均纳入研究。此外，在研究的前5年，还通过社区先证者及其配偶、一级亲属招募了社区对照家系。

每次随访间隔约4年，既纳入新受试者，也对已入组对象开展随访检查。前三次随访均在受试者家中完成，涵盖夜间睡眠监测等数据采集；最后一次随访则于综合临床研究中心（general clinical research center, GCRC）开展。全队列的表型评估包括夜间睡眠呼吸暂停监测、血压测量、肺量测定、人体测量学检测及问卷调查。目前，共有710名受试者的数据可通过BioData Catalyst获取（基因型数据可通过dbGaP获取）。

国家睡眠研究资源（National Sleep Research Resource, NSRR）是由NIH资助的睡眠数据资源库，面向公众免费提供多队列研究、临床试验及其他数据源中去标识化的生理信号与相关临床数据，涵盖儿童与成人群体，包括社区健康个体及已确诊睡眠或其他健康障碍的人群。NSRR的目标是推动需要大规模或多样化数据集（包括原始生理信号）的严谨研究，以加深对睡眠与昼夜节律紊乱风险因素、以及睡眠障碍对健康相关转归影响的理解。截至2022年2月，该资源库已整合超过15个数据源、4万余项个体睡眠研究数据，其中多数关联了数十乃至上百项临床数据变量。平台提供查询工具以检索目标变量、元数据及溯源信息。

### 纳入与排除标准
#### 纳入标准
病例组为经实验室确诊的阻塞性睡眠呼吸暂停先证者（呼吸暂停低通气指数>15或接受持续气道正压通气（CPAP）治疗）。所有病例及其一级亲属、选择性二级亲属与配偶共同组成“病例家系”队列。
对照先证者选自病例先证者的社区邻居，其一级亲属与配偶组成“对照家系”队列。

#### 排除标准
无法提供知情同意；与病例或对照家系无亲属关系；病例存在与睡眠呼吸暂停相关的已知先天性疾病。

### 纵向数据说明
克利夫兰家族研究包含纵向数据（每名受试者可拥有多条观测记录）。随访次数最多可达4次，跨度达15年。新受试者会在后续的数据收集阶段入组，因此每名受试者可拥有1至4次随访数据。变量VISIT用于标记随访类型，现有VISIT #1（1990-2001）、VISIT #2（1996-2001）、VISIT #3（1999-2001）与VISIT #5（2001-2005），无VISIT #4。这些随访并非按“波次”开展，而是仅记录实际开展的随访编号。招募采用滚动式，因此部分受试者仅完成首次随访（VISIT=1），其余受试者则完成了第二次或第三次随访（VISIT=2或3）。

前三次随访均在受试者家中完成。参与第二次、第三次随访的受试者多为既往随访过的对象。后续招募的新增家庭成员与少数族裔家系，根据采集的数据类型分别被标记为VISIT 1或VISIT 5。VISIT 5在专属临床研究单元（GCRU）开展，该次随访针对少数族裔家系及既往完成微卫星检测（因遗传信息充足而入选）的家系。VISIT 5的数据采集更为全面，除涵盖既往检测项目外，还增加了更细致的生化检测、心电图、内皮功能检测及睡眠分期数据。因此，VISIT=5的数据为克利夫兰家族研究中受试者的最新随访数据，代表了最完整的采集方案，但仅覆盖710名受试者。