title: Obstructive sleep apnea is associated with future subclinical carotid artery disease: thirteen-year follow-up from the Wisconsin sleep cohort.
abstract: OBJECTIVE
  To determine the longitudinal associations between obstructive sleep apnea, carotid artery intima-media thickness (IMT), and plaque.
  
  
  RESULTS
  This is a population-based, prospective cohort study conducted from July, 1989, to November, 2012, on 790 randomly selected Wisconsin residents who completed a mean of 3.5 (range, 1-6) polysomnograms during the study period. Obstructive sleep apnea was characterized by the apnea-hypopnea index (AHI, events/h). Common carotid artery IMT and plaque were assessed by B-mode ultrasound. The mean (SD) time from the first polysomnograms to carotid ultrasound was 13.5 (3.6) years. Multivariable regression models were created to estimate the independent associations of baseline and cumulative obstructive sleep apnea exposure with subsequent carotid IMT and plaque. At baseline, the mean age of participants was 47.6 (7.7) years (55% men, 97% white). AHI was 4.4 (9.0) events/h (range, 0-97); 7% had AHI >15 events/h. Carotid IMT was 0.755 (0.161) mm; 63% had plaque. Adjusting for age, sex, body mass index, systolic blood pressure, smoking, and use of lipid-lowering, antihypertensive, and antidiabetic medications, baseline AHI independently predicted future carotid IMT (β=0.027 mm/unit log10[AHI+1]; P=0.049), plaque presence (odds ratio, 1.55 [95% confidence intervals, 1.02-2.35]; P=0.041) and plaque score (odds ratio, 1.30 [1.05-1.61]; P=0.018). In cumulative risk factor-adjusted models, AHI independently predicted future carotid plaque presence (P=0.012) and score (P=0.039), but not IMT (P=0.608).
  
  
  CONCLUSIONS
  Prevalent obstructive sleep apnea is independently associated with increased carotid IMT and plaque more than a decade later, indicating increased future cardiovascular disease risk.
authors.affiliation: From the Department of Medicine (S.I.G., C.E.K., S.E.A., K.M.H., J.H.S.) and Department of Population Health Sciences (P.E.P., J.H.B., E.W.H., T.Y., K.M.H., J.H.S.), School of Medicine and Public Health, University of Wisconsin, Madison.
authors.forename: Sverrir I
authors.initials: SI
authors.lastname: Gunnarsson
authors.affiliation: From the Department of Medicine (S.I.G., C.E.K., S.E.A., K.M.H., J.H.S.) and Department of Population Health Sciences (P.E.P., J.H.B., E.W.H., T.Y., K.M.H., J.H.S.), School of Medicine and Public Health, University of Wisconsin, Madison.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Peppard
authors.affiliation: From the Department of Medicine (S.I.G., C.E.K., S.E.A., K.M.H., J.H.S.) and Department of Population Health Sciences (P.E.P., J.H.B., E.W.H., T.Y., K.M.H., J.H.S.), School of Medicine and Public Health, University of Wisconsin, Madison.
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Korcarz
authors.affiliation: From the Department of Medicine (S.I.G., C.E.K., S.E.A., K.M.H., J.H.S.) and Department of Population Health Sciences (P.E.P., J.H.B., E.W.H., T.Y., K.M.H., J.H.S.), School of Medicine and Public Health, University of Wisconsin, Madison.
authors.forename: Jodi H
authors.initials: JH
authors.lastname: Barnet
authors.affiliation: From the Department of Medicine (S.I.G., C.E.K., S.E.A., K.M.H., J.H.S.) and Department of Population Health Sciences (P.E.P., J.H.B., E.W.H., T.Y., K.M.H., J.H.S.), School of Medicine and Public Health, University of Wisconsin, Madison.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Aeschlimann
authors.affiliation: From the Department of Medicine (S.I.G., C.E.K., S.E.A., K.M.H., J.H.S.) and Department of Population Health Sciences (P.E.P., J.H.B., E.W.H., T.Y., K.M.H., J.H.S.), School of Medicine and Public Health, University of Wisconsin, Madison.
authors.forename: Erika W
authors.initials: EW
authors.lastname: Hagen
authors.affiliation: From the Department of Medicine (S.I.G., C.E.K., S.E.A., K.M.H., J.H.S.) and Department of Population Health Sciences (P.E.P., J.H.B., E.W.H., T.Y., K.M.H., J.H.S.), School of Medicine and Public Health, University of Wisconsin, Madison.
authors.forename: Terry
authors.initials: T
authors.lastname: Young
authors.affiliation: From the Department of Medicine (S.I.G., C.E.K., S.E.A., K.M.H., J.H.S.) and Department of Population Health Sciences (P.E.P., J.H.B., E.W.H., T.Y., K.M.H., J.H.S.), School of Medicine and Public Health, University of Wisconsin, Madison.
authors.forename: K Mae
authors.initials: KM
authors.lastname: Hla
authors.affiliation: From the Department of Medicine (S.I.G., C.E.K., S.E.A., K.M.H., J.H.S.) and Department of Population Health Sciences (P.E.P., J.H.B., E.W.H., T.Y., K.M.H., J.H.S.), School of Medicine and Public Health, University of Wisconsin, Madison. jhs@medicine.wisc.edu.
authors.forename: James H
authors.initials: JH
authors.lastname: Stein
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D058070:Asymptomatic Diseases; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D017286:Polysomnography; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D013997:Time Factors; D014922:Wisconsin / Q000453:epidemiology
keywords: atherosclerosis; carotid arteries; epidemiology; sleep apnea syndromes; sleep disorders; ultrasonography