title: A systematic assessment of the association of polysomnographic indices with blood pressure: the Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: OBJECTIVE
  Blood pressure (BP) may be adversely affected by a variety of sleep disturbances, including sleep fragmentation, hypoxemia, respiratory disturbances, and periodic limb movements. We aim to identify which polysomnography indices are most strongly and consistently associated with systolic and diastolic blood pressure (SBP, DBP) levels in a population-based sample.
  
  
  METHODS
  Cross-sectional analysis of data from 2,040 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent polysomnography at MESA Exam 5 in 2011-2013.
  
  
  METHODS
  Multisite cohort study.
  
  
  METHODS
  Participants were mean age 68 y (54% females; 28% African American, 24% Hispanic, 11% Chinese).
  
  
  METHODS
  Thirty-two candidate polysomnography predictors were identified representing the domains of breathing disturbance frequency, hypoxemia, sleep architecture, and periodic limb movements. Cluster analysis was used for variable reduction. Statistical models, adjusted for potential confounders, were derived using stepwise regression. Final models were selected using cross-validation techniques.
  
  
  RESULTS
  The apnea-hypopnea index (AHI) defined using a 4% desaturation hypopnea criterion (AHI4P) was most consistently associated with SBP level. The AHI and periodic limb movement index (associated with arousals; PLMIA) were significantly associated with DBP. Estimated adjusted differences in SBP and DBP levels between an individual with no sleep apnea (AHI4P = 0) and one with moderately severe sleep apnea (AHI4P = 30) were 2.2 mm Hg and 1.1 mm Hg, respectively. Each 10-unit increase in the PLMIA was associated with an increase in DBP of 1.2 mm Hg.
  
  
  CONCLUSIONS
  Our results support the use of a currently recommended apnea-hypopnea index definition as a marker of blood pressure risk and indicate that measurement of limb movements with arousals is also independently associated with diastolic blood pressure.
authors.affiliation: Brigham and Women's Hospital, Boston, MA.|Harvard Medical School, Boston, MA.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Dean
authors.affiliation: Brigham and Women's Hospital, Boston, MA.|Harvard Medical School, Boston, MA.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: University of Minnesota, Duluth, MN.
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: University of Minnesota, Duluth, MN.
authors.forename: Daniel
authors.initials: D
authors.lastname: Duprez
authors.affiliation: Johns Hopkins University, Evanston, IL.
authors.forename: Naresh M
authors.initials: NM
authors.lastname: Punjabi
authors.affiliation: Northwestern University, Evanston, IL.
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Zee
authors.affiliation: Columbia University, New York, NY.
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.affiliation: University of California at Los Angeles, Los Angeles, CA.
authors.forename: Karol
authors.initials: K
authors.lastname: Watson
authors.affiliation: Brigham and Women's Hospital, Boston, MA.|Harvard Medical School, Boston, MA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
mesh_terms: D000368:Aged; D001143:Arousal / Q000502:physiology; D050197:Atherosclerosis; D001794:Blood Pressure / Q000502:physiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology; D008297:Male; D009068:Movement; D017286:Polysomnography; D012119:Respiration; D012890:Sleep / Q000502:physiology*; D012891:Sleep Apnea Syndromes / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000503:physiopathology*
keywords: cluster analysis; cohort study; cross validation; diastolic blood pressure; hypertension; imputation; multiethnic; sleep exposure; systolic blood pressure