title: Coronary heart disease incidence in sleep disordered breathing: the Wisconsin Sleep Cohort Study.
abstract: OBJECTIVE
  The aim of the study was to determine the association of objectively measured sleep disordered breathing (SDB) with incident coronary heart disease (CHD) or heart failure (HF) in a nonclinical population.
  
  
  METHODS
  Longitudinal analysis of a community-dwelling cohort followed up to 24 y.
  
  
  METHODS
  Sleep laboratory at the Clinical Research Unit of the University of Wisconsin Hospital and Clinics.
  
  
  METHODS
  There were 1,131 adults who completed one or more overnight polysomnography studies, were free of CHD or HF at baseline, were not treated by continuous positive airway pressure (CPAP), and followed over 24 y.
  
  
  METHODS
  None.
  
  
  RESULTS
  In-laboratory overnight polysomnography was used to assess SDB, defined by the apnea-hypopnea index (AHI) using apnea and hypopnea events per hour of sleep. Incident CHD or HF was defined by new reports of myocardial infarction, coronary revascularization procedures, congestive heart failure, and cardiovascular deaths. We used baseline AHI as the predictor variable in survival analysis models predicting CHD or HF incidence adjusted for traditional confounders. The incidence of CHD or HF was 10.9/1,000 person-years. The mean time to event was 11.2 ± 5.8 y. After adjusting for age, sex, body mass index, and smoking, estimated hazard ratios (95% confidence interval) of incident CHD or HF were 1.5 (0.9-2.6) for AHI > 0-5, 1.9 (1.05-3.5) for AHI 5 ≤ 15, 1.8 (0.85-4.0) for AHI 15 ≤ 30, and 2.6 (1.1-6.1) for AHI > 30 compared to AHI = 0 (P trend = 0.02).
  
  
  CONCLUSIONS
  Participants with untreated severe sleep disordered breathing (AHI > 30) were 2.6 times more likely to have an incident coronary heart disease or heart failure compared to those without sleep disordered breathing. Our findings support the postulated adverse effects of sleep disordered breathing on coronary heart disease and heart failure.
authors.affiliation: Departments of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Khin Mae
authors.initials: KM
authors.lastname: Hla
authors.affiliation: Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Terry
authors.initials: T
authors.lastname: Young
authors.affiliation: Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Erika W
authors.initials: EW
authors.lastname: Hagen
authors.affiliation: Departments of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: James H
authors.initials: JH
authors.lastname: Stein
authors.affiliation: Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Finn
authors.affiliation: Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Nieto
authors.affiliation: Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Peppard
mesh_terms: D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D017286:Polysomnography; D012111:Residence Characteristics; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D016019:Survival Analysis; D014922:Wisconsin / Q000453:epidemiology
keywords: coronary heart disease; heart failure; sleep disordered breathing