title: Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study.
abstract: Disordered breathing during sleep is associated with acute, unfavorable effects on cardiovascular physiology, but few studies have examined its postulated association with cardiovascular disease (CVD). We examined the cross-sectional association between sleep- disordered breathing and self-reported CVD in 6,424 free-living individuals who underwent overnight, unattended polysomnography at home. Sleep-disordered breathing was quantified by the apnea-hypopnea index (AHI)-the average number of apneas and hypopneas per hour of sleep. Mild to moderate disordered breathing during sleep was highly prevalent in the sample (median AHI: 4.4; interquartile range: 1.3 to 11.0). A total of 1,023 participants (16%) reported at least one manifestation of CVD (myocardial infarction, angina, coronary revascularization procedure, heart failure, or stroke). The multivariable-adjusted relative odds (95% CI) of prevalent CVD for the second, third, and fourth quartiles of the AHI (versus the first) were 0.98 (0.77-1.24), 1.28 (1.02-1.61), and 1.42 (1.13-1.78), respectively. Sleep-disordered breathing was associated more strongly with self-reported heart failure and stroke than with self-reported coronary heart disease: the relative odds (95% CI) of heart failure, stroke, and coronary heart disease (upper versus lower AHI quartile) were 2.38 (1.22-4.62), 1.58 (1.02- 2.46), and 1.27 (0.99-1.62), respectively. These findings are compatible with modest to moderate effects of sleep-disordered breathing on heterogeneous manifestations of CVD within a range of AHI values that are considered normal or only mildly elevated.
authors.affiliation: Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: E
authors.initials: E
authors.lastname: Shahar
authors.forename: C W
authors.initials: CW
authors.lastname: Whitney
authors.forename: S
authors.initials: S
authors.lastname: Redline
authors.forename: E T
authors.initials: ET
authors.lastname: Lee
authors.forename: A B
authors.initials: AB
authors.lastname: Newman
authors.forename: F J
authors.initials: FJ
authors.lastname: Nieto
authors.forename: G T
authors.initials: GT
authors.lastname: O'Connor
authors.forename: L L
authors.initials: LL
authors.lastname: Boland
authors.forename: J E
authors.initials: JE
authors.lastname: Schwartz
authors.forename: J M
authors.initials: JM
authors.lastname: Samet
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012891:Sleep Apnea Syndromes / Q000150:complications*