title: The relationship between obstructive sleep apnea and self-reported stroke or coronary heart disease in overweight and obese adults with type 2 diabetes mellitus.
abstract: OBJECTIVE
  Type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) are common, increasingly recognized as comorbid conditions, and individually implicated in the development of cardiovascular disease (CVD). We sought to determine the association between OSA and CVD in an overweight and obese population with T2DM.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Ancillary study to the Look AHEAD trial.
  
  
  METHODS
  Three hundred five participants of the Sleep AHEAD study who underwent unattended full polysomnography at home with measurement of the apnea-hypopnea index (AHI).
  
  
  RESULTS
  Self-reported prevalent CVD was obtained at the initial assessment of the parent study and included a history of the following conditions: stroke, carotid endarterectomy, myocardial infarction, coronary artery bypass grafting, and percutaneous coronary intervention. Logistic regression was used to assess the association of OSA, measured continuously and categorically, with prevalent CVD. OSA was present (AHI ≥ 5) in 86% of the population, whereas the prevalence of all forms of CVD was just 14%. The AHI was associated with stroke with an adjusted odds ratio (95% confidence interval) of 2.57 (1.03, 6.42). Neither the continuously measured AHI nor the categories of OSA severity were significantly associated with the other forms of CVD assessed.
  
  
  CONCLUSIONS
  We found suggestive evidence of a greater prevalence of stroke at greater values of the AHI. OSA was not associated with prevalent coronary heart disease in the Sleep AHEAD trial. Future studies should confirm the link between OSA and stroke and examine mechanisms that link OSA to stroke in adults with T2DM.
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA. ricetb@upmc.edu
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Rice
authors.forename: Gary D
authors.initials: GD
authors.lastname: Foster
authors.forename: Mark H
authors.initials: MH
authors.lastname: Sanders
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
authors.forename: David
authors.initials: D
authors.lastname: Reboussin
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Kuna
authors.forename: Richard
authors.initials: R
authors.lastname: Millman
authors.forename: Gary
authors.initials: G
authors.lastname: Zammit
authors.forename: Rena R
authors.initials: RR
authors.lastname: Wing
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Wadden
authors.forename: David
authors.initials: D
authors.lastname: Kelley
authors.forename: Xavier
authors.initials: X
authors.lastname: Pi-Sunyer
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
mesh_terms: D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology*; D017286:Polysomnography / Q000379:methods; D015995:Prevalence; D012307:Risk Factors; D057566:Self Report; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology*