title: Association between sleep apnea, snoring, incident cardiovascular events and all-cause mortality in an adult population: MESA.
abstract: BACKGROUND
  We assessed the association between sleep apnea, snoring, incident cardiovascular (CV) events and all-cause mortality in the Multi Ethnic Study of Atherosclerosis (MESA) cohort.
  
  
  METHODS
  Out of 5338 respondents to a sleep questionnaire administered during the second MESA exam period, 208 had physician diagnosed sleep apnea (PDSA), 1452 were habitual snorers (HS) and 3678 were neither a habitual snorer nor had PDSA (normal participants). Cox proportional hazard analysis was used to assess the associations adjusting for age, gender, race/ethnicity, smoking, diabetes mellitus, total cholesterol, HDL, triglycerides, BMI, current alcohol use, benzodiazepine use, BP medications and statin use.
  
  
  RESULTS
  Over a 7.5 year average follow-up period, 310 adjudicated CV events including MI, stroke, angina, resuscitated cardiac arrest, stroke death and CVD death and 189 deaths occurred. Compared to HS, PDSA was associated with higher incident CV rates in both univariate and multivariable models [hazard ratio (95%); 1.89 (1.22-2.93), p = 0.004 and 1.91 (1.20-3.04), p = 0.007, respectively]. PDSA was also associated with a higher death rates compared with HS [hazard ratio (95%); 2.13 (1.25-3.63), p = 0.006 and 2.70 (1.52-4.79), p = 0.007, respectively]. Compared with normal participants, PDSA had higher incident CV event rates in both univariate and multivariable models [hazard ratio (95%); 2.23 [1.39-3.60], p = 0.001 and 2.16 [1.30-3.58], p = 0.003, respectively]. Similarly, PDSA had a higher death rate compared with normal participants in both the univariate and multivariable models [hazard ratio (95% CI); 2.44 (1.36-4.37), p = 0.003 and 2.71 (1.45-5.08), p =0 .002, respectively]. Habitual snorers had similar incident CV event rates and death rates in both univariate and multivariable models compared with normal participants.
  
  
  CONCLUSIONS
  PDSA but not habitual snoring was associated with high incident CV events and all-cause mortality in a multi-ethnic population based study of adults free of clinical CV disease at baseline.
authors.affiliation: Department of Medicine/Cardiology, Wake Forest University Health Sciences, Winston Salem, NC 27157, United States. jyeboah@wfubmc.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: Yeboah
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.forename: Craig
authors.initials: C
authors.lastname: Johnson
authors.forename: Russell
authors.initials: R
authors.lastname: Tracy
authors.forename: Pamela
authors.initials: P
authors.lastname: Ouyang
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
authors.forename: David M
authors.initials: DM
authors.lastname: Herrington
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000401:mortality*; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality*; D012913:Snoring / Q000208:ethnology / Q000401:mortality*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
references.citation: JAMA. 2003 Oct 8;290(14):1906-14
references.pmid: 14532320
references.citation: J Am Coll Cardiol. 2008 Aug 19;52(8):686-717
references.pmid: 18702977
references.citation: PLoS Med. 2009 Aug;6(8):e1000132
references.pmid: 19688045
references.citation: Circulation. 2004 Mar 2;109(8):951-7
references.pmid: 14993147
references.citation: Am J Respir Crit Care Med. 2005 Dec 1;172(11):1447-51
references.pmid: 16141444
references.citation: Clin Chem. 1972 Jun;18(6):499-502
references.pmid: 4337382
references.citation: Chest. 2008 Mar;133(3):793-804
references.pmid: 18321908
references.citation: Lancet. 1985 Dec 14;2(8468):1325-6
references.pmid: 2866387
references.citation: Am J Respir Crit Care Med. 2010 Jul 15;182(2):269-77
references.pmid: 20339144
references.citation: Circulation. 2008 Aug 26;118(9):955-60
references.pmid: 18697817
references.citation: Stroke. 1989 Oct;20(10):1311-5
references.pmid: 2799862
references.citation: Stroke. 1991 Aug;22(8):1021-5
references.pmid: 1866748
references.citation: Am J Respir Crit Care Med. 2001 Jan;163(1):19-25
references.pmid: 11208620
references.citation: Eur Respir J. 2007 Jan;29(1):156-78
references.pmid: 17197482
references.citation: Am J Epidemiol. 2002 Nov 1;156(9):871-81
references.pmid: 12397006
references.citation: Hypertension. 2008 Mar;51(3):605-8
references.pmid: 18227409
references.citation: Atherosclerosis. 2010 Feb;208(2):490-5
references.pmid: 19762024
references.citation: Circulation. 2010 Jul 27;122(4):352-60
references.pmid: 20625114
references.citation: Circulation. 2003 Apr 1;107(12):1671-8
references.pmid: 12668504
references.citation: Respir Care. 2010 Sep;55(9):1155-67
references.pmid: 20799998
references.citation: Circulation. 2009 Aug 11;120(6):502-9
references.pmid: 19635967
references.citation: Chest. 2008 Feb;133(2):496-506
references.pmid: 18252916
references.citation: Clin Chest Med. 2003 Jun;24(2):179-93
references.pmid: 12800777
references.citation: Sleep. 1996 Dec;19(10 Suppl):S213-7
references.pmid: 9085514
references.citation: N Engl J Med. 2005 Nov 10;353(19):2034-41
references.pmid: 16282178
references.citation: Lancet. 2002 Jul 20;360(9328):237-45
references.pmid: 12133673
references.citation: Stroke. 2006 Sep;37(9):2317-21
references.pmid: 16888274
references.citation: Chest. 2009 Dec;136(6):1668-1677
references.pmid: 19995768
references.citation: Sleep. 2007 Mar;30(3):291-303
references.pmid: 17425225