title: Obstructive sleep apnea and progression of coronary artery calcium: the multi-ethnic study of atherosclerosis study.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is a common condition associated with cardiovascular disease. Its potential effect on progression of subclinical atherosclerosis is not well understood. We tested the hypothesis that self-reported OSA is associated with progression of coronary artery calcium (CAC). We also evaluated whether traditional cardiovascular risk factors accounted for the association.
  
  
  RESULTS
  In the Multi-Ethnic Study of Atherosclerosis (MESA) prospective cohort, we studied 2603 participants who at baseline (2002-2004) completed a sleep questionnaire and underwent coronary computed tomography (CT) and, then 8 years later (2010-2011), a repeat coronary CT. Participants were categorized by symptoms of habitual snoring or reported physician diagnosis of OSA. At baseline, 102 (3.9%) reported diagnosed OSA; 666 (25.6%) reported diagnosed habitual snoring; and 1835 (70.5%) reported neither habitual snoring nor OSA ("normal"). At baseline, CAC prevalence was highest among those with OSA but similar for those with and without habitual snoring. During 8 years of follow-up, greater progression of CAC was observed among those with OSA versus normal (mean increase of 204.2 versus 135.5 Agatston units; P=0.01), after accounting for demographics, behaviors, and body habitus. Modest attenuation was observed after adjustment for cardiovascular risk factors (188.7 versus 138.8; P=0.06). CAC progression among habitual snorers was similar to that observed in the normal group.
  
  
  CONCLUSIONS
  OSA was associated with CAC score progression after adjustment for demographics, behaviors, and body mass index. However, the association was not significant after accounting for cardiovascular risk factors, which may mediate the association between OSA and CAC.
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN (Y.K., D.A.D.).
authors.forename: Younghoon
authors.initials: Y
authors.lastname: Kwon
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN (Y.K., D.A.D.).
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Duprez
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (D.R.J., P.L.L.).
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan (M.N.).
authors.forename: Mako
authors.initials: M
authors.lastname: Nagayoshi
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA (R.L.M.C.).
authors.forename: Robyn L
authors.initials: RL
authors.lastname: McClelland
authors.affiliation: College of Public Health, University of Arizona, Tuscan, AZ (E.S.).
authors.forename: Eyal
authors.initials: E
authors.lastname: Shahar
authors.affiliation: Harbor-UCLA Los Angeles Biomedical Research Institute, Torrance, CA (M.B.).
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.).
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Department of Medicine, Columbia University, New York, NY (S.S.).
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.affiliation: Department of Radiology, Vanderbilt University, Nashville, TN (J.C.).
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (D.R.J., P.L.L.).
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Lutsey
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000175:diagnosis / Q000453:epidemiology*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000208:ethnology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL
keywords: coronary artery calcium; obstructive sleep apnea; snoring; subclinical atherosclerosis risk factor