title: Sleep apnea is independently associated with peripheral arterial disease in the Hispanic Community Health Study/Study of Latinos.
abstract: OBJECTIVE
  Sleep apnea (SA) has been linked with various forms of cardiovascular disease, but little is known about its association with peripheral artery disease (PAD) measured using the ankle-brachial index. This relationship was evaluated in the Hispanic Community Health Study/Study of Latinos.
  
  
  RESULTS
  We studied 8367 Hispanic Community Health Study/Study of Latinos participants who were 45 to 74 years of age. Sleep symptoms were examined with the self-reported Sleep Health Questionnaire. SA was assessed using an in-home sleep study. Systolic blood pressure was measured in all extremities to compute the ankle-brachial index. PAD was defined as ankle-brachial index <0.90 in either leg. Multivariable logistic regression was used to investigate the association between moderate-to-severe SA, defined as apnea-hypopnea index ≥15, and the presence of PAD. Analyses were adjusted for covariates. The prevalence of PAD was 4.7% (n=390). The mean apnea-hypopnea index was significantly higher among adults with PAD compared with those without (11.1 versus 8.6 events/h; P=0.046). After adjusting for covariates, moderate-to-severe SA was associated with a 70% increase in the odds of PAD (odds ratio, 1.7; 95% confidence interval, 1.1-2.5; P=0.0152). This association was not modified by sex (P=0.8739). However, there was evidence that the association between moderate-to-severe SA and PAD varied by Hispanic/Latino background (P<0.01). Specifically, the odds were stronger in Mexican (adjusted odds ratio, 2.9; 95% confidence interval, 1.3-6.2) and in Puerto Rican Americans (adjusted odds ratio, 2.0; 95% confidence interval, 0.97-4.2) than in other backgrounds.
  
  
  CONCLUSIONS
  Moderate-to-severe SA is associated with higher odds of PAD in Hispanic/Latino adults.
authors: From the Department of Medicine, Montefiore Medical Center (N.S.) and Department of Epidemiology and Population Health (N.S., S.W.-S., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, University of Southern California San Diego, La Jolla (M.A., M.H.C., L.C.G.); Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Y.T., D.S.-A.); Department of Medicine, University of Miami, FL (A.R.R.); Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.C.Z.); Department of Medicine, Yale School of Medicine, New Haven, CT (H.K.Y.); and Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.). nshah@montefiore.org.
authors: Neomi
authors: N
authors: Shah
authors: From the Department of Medicine, Montefiore Medical Center (N.S.) and Department of Epidemiology and Population Health (N.S., S.W.-S., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, University of Southern California San Diego, La Jolla (M.A., M.H.C., L.C.G.); Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Y.T., D.S.-A.); Department of Medicine, University of Miami, FL (A.R.R.); Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.C.Z.); Department of Medicine, Yale School of Medicine, New Haven, CT (H.K.Y.); and Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.).
authors: Matthew
authors: M
authors: Allison
authors: From the Department of Medicine, Montefiore Medical Center (N.S.) and Department of Epidemiology and Population Health (N.S., S.W.-S., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, University of Southern California San Diego, La Jolla (M.A., M.H.C., L.C.G.); Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Y.T., D.S.-A.); Department of Medicine, University of Miami, FL (A.R.R.); Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.C.Z.); Department of Medicine, Yale School of Medicine, New Haven, CT (H.K.Y.); and Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.).
authors: Yanping
authors: Y
authors: Teng
authors: From the Department of Medicine, Montefiore Medical Center (N.S.) and Department of Epidemiology and Population Health (N.S., S.W.-S., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, University of Southern California San Diego, La Jolla (M.A., M.H.C., L.C.G.); Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Y.T., D.S.-A.); Department of Medicine, University of Miami, FL (A.R.R.); Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.C.Z.); Department of Medicine, Yale School of Medicine, New Haven, CT (H.K.Y.); and Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.).
authors: Sylvia
authors: S
authors: Wassertheil-Smoller
authors: From the Department of Medicine, Montefiore Medical Center (N.S.) and Department of Epidemiology and Population Health (N.S., S.W.-S., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, University of Southern California San Diego, La Jolla (M.A., M.H.C., L.C.G.); Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Y.T., D.S.-A.); Department of Medicine, University of Miami, FL (A.R.R.); Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.C.Z.); Department of Medicine, Yale School of Medicine, New Haven, CT (H.K.Y.); and Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.).
authors: Daniela
authors: D
authors: Sotres-Alvarez
authors: From the Department of Medicine, Montefiore Medical Center (N.S.) and Department of Epidemiology and Population Health (N.S., S.W.-S., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, University of Southern California San Diego, La Jolla (M.A., M.H.C., L.C.G.); Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Y.T., D.S.-A.); Department of Medicine, University of Miami, FL (A.R.R.); Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.C.Z.); Department of Medicine, Yale School of Medicine, New Haven, CT (H.K.Y.); and Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.).
authors: Alberto R
authors: AR
authors: Ramos
authors: From the Department of Medicine, Montefiore Medical Center (N.S.) and Department of Epidemiology and Population Health (N.S., S.W.-S., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, University of Southern California San Diego, La Jolla (M.A., M.H.C., L.C.G.); Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Y.T., D.S.-A.); Department of Medicine, University of Miami, FL (A.R.R.); Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.C.Z.); Department of Medicine, Yale School of Medicine, New Haven, CT (H.K.Y.); and Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.).
authors: Phyllis C
authors: PC
authors: Zee
authors: From the Department of Medicine, Montefiore Medical Center (N.S.) and Department of Epidemiology and Population Health (N.S., S.W.-S., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, University of Southern California San Diego, La Jolla (M.A., M.H.C., L.C.G.); Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Y.T., D.S.-A.); Department of Medicine, University of Miami, FL (A.R.R.); Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.C.Z.); Department of Medicine, Yale School of Medicine, New Haven, CT (H.K.Y.); and Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.).
authors: Michael H
authors: MH
authors: Criqui
authors: From the Department of Medicine, Montefiore Medical Center (N.S.) and Department of Epidemiology and Population Health (N.S., S.W.-S., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, University of Southern California San Diego, La Jolla (M.A., M.H.C., L.C.G.); Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Y.T., D.S.-A.); Department of Medicine, University of Miami, FL (A.R.R.); Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.C.Z.); Department of Medicine, Yale School of Medicine, New Haven, CT (H.K.Y.); and Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.).
authors: Henry K
authors: HK
authors: Yaggi
authors: From the Department of Medicine, Montefiore Medical Center (N.S.) and Department of Epidemiology and Population Health (N.S., S.W.-S., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, University of Southern California San Diego, La Jolla (M.A., M.H.C., L.C.G.); Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Y.T., D.S.-A.); Department of Medicine, University of Miami, FL (A.R.R.); Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.C.Z.); Department of Medicine, Yale School of Medicine, New Haven, CT (H.K.Y.); and Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.).
authors: Linda C
authors: LC
authors: Gallo
authors: From the Department of Medicine, Montefiore Medical Center (N.S.) and Department of Epidemiology and Population Health (N.S., S.W.-S., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, University of Southern California San Diego, La Jolla (M.A., M.H.C., L.C.G.); Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Y.T., D.S.-A.); Department of Medicine, University of Miami, FL (A.R.R.); Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.C.Z.); Department of Medicine, Yale School of Medicine, New Haven, CT (H.K.Y.); and Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.).
authors: Susan
authors: S
authors: Redline
authors: From the Department of Medicine, Montefiore Medical Center (N.S.) and Department of Epidemiology and Population Health (N.S., S.W.-S., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, University of Southern California San Diego, La Jolla (M.A., M.H.C., L.C.G.); Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Y.T., D.S.-A.); Department of Medicine, University of Miami, FL (A.R.R.); Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.C.Z.); Department of Medicine, Yale School of Medicine, New Haven, CT (H.K.Y.); and Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.).
authors: Robert C
authors: RC
authors: Kaplan
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D016015:Logistic Models; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000208:ethnology*; D011647:Puerto Rico / Q000208:ethnology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000208:ethnology*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: Hispanic Americans; ankle–brachial index; atherosclerosis; peripheral arterial disease; sleep apnea syndromes
references: Vasc Med. 2009 Nov;14(4):351-60
references: 19808720
references: Sleep Breath. 2010 Dec;14(4):365-70
references: 20084549
references: Clin Cardiol. 2012 Oct;35(10):641-5
references: 22949086
references: Auton Neurosci. 2001 Jul 20;90(1-2):89-94
references: 11485297
references: Respir Med. 2012 May;106(5):740-6
references: 22317765
references: Am J Respir Crit Care Med. 2005 Sep 1;172(5):613-8
references: 15901608
references: Sleep Breath. 2010 Jun;14(2):131-6
references: 19777281
references: Stroke. 2002 Jul;33(7):1782-5
references: 12105352
references: Diabetes Care. 2012 Aug;35(8):1731-5
references: 22699294
references: Zhonghua Jie He He Hu Xi Za Zhi. 2006 Jun;29(6):395-8
references: 17045022
references: Lung. 2008 Jul-Aug;186(4):209-17
references: 18365276
references: Am J Respir Crit Care Med. 2005 Sep 1;172(5):625-30
references: 16120716
references: Lancet. 2005 Mar 19-25;365(9464):1046-53
references: 15781100
references: Intern Med. 2004 Mar;43(3):184-8
references: 15098597
references: Curr Med Res Opin. 2008 Sep;24(9):2509-22
references: 18664318
references: Am J Respir Crit Care Med. 2001 Jan;163(1):19-25
references: 11208620
references: Multidiscip Respir Med. 2013 Feb 06;8(1):9
references: 23384202
references: Respir Res. 2012;13:22
references: 22424053
references: Sleep Med Rev. 2003 Feb;7(1):35-51
references: 12586529
references: Chest. 2011 Aug;140(2):534-42
references: 21813534
references: Sleep. 2004 Feb 1;27(1):129-33
references: 14998249
references: Atherosclerosis. 2008 Mar;197(1):125-31
references: 17433330
references: N Engl J Med. 2000 May 11;342(19):1378-84
references: 10805822
references: Eur Respir J. 1999 Jul;14(1):179-84
references: 10489848
references: Sleep. 2007 Jan;30(1):29-34
references: 17310862
references: Circulation. 1985 Mar;71(3):510-5
references: 3156006
references: Sleep. 2004 Sep 15;27(6):1113-20
references: 15532205
references: Nat Rev Cardiol. 2011 Apr;8(4):197-206
references: 21283149
references: N Engl J Med. 2005 Mar 24;352(12):1206-14
references: 15788497
references: Am J Respir Crit Care Med. 2002 Mar 1;165(5):677-82
references: 11874813
references: Am J Med. 2009 Dec;122(12):1122-7
references: 19958890
references: Respir Physiol Neurobiol. 2007 Feb 15;155(2):121-7
references: 16790368
references: Am J Respir Crit Care Med. 2006 Apr 15;173(8):910-6
references: 16424443
references: Atherosclerosis. 2012 Jun;222(2):483-9
references: 22560328
references: Am J Respir Crit Care Med. 2004 Feb 1;169(3):354-60
references: 14551166
references: J Clin Ultrasound. 2005 Feb;33(2):80-6
references: 15674835
references: Circulation. 2010 Jul 27;122(4):352-60
references: 20625114
references: Respiration. 2006;73(6):741-50
references: 16717439
references: Hypertension. 2009 Jan;53(1):64-9
references: 19015401
references: Am J Respir Crit Care Med. 2007 Oct 1;176(7):706-12
references: 17556718
references: Atherosclerosis. 2006 Nov;189(1):61-9
references: 16620828
references: Chest. 2005 Nov;128(5):3407-12
references: 16304292
references: Circulation. 2003 Mar 4;107(8):1129-34
references: 12615790
references: Eur Respir J. 2013 Mar;41(3):616-20
references: 22700841
references: J Oral Maxillofac Surg. 1998 Aug;56(8):950-4
references: 9710189
references: Arch Intern Med. 1997 Aug 11-25;157(15):1746-52
references: 9250236
references: Am J Respir Crit Care Med. 2014 Feb 1;189(3):335-44
references: 24392863
references: N Engl J Med. 2005 Nov 10;353(19):2034-41
references: 16282178
references: Atherosclerosis. 2010 Feb;208(2):490-5
references: 19762024
references: Eur Respir J. 2013 Nov;42(5):1263-70
references: 23471346
references: Circulation. 2006 Mar 21;113(11):e463-654
references: 16549646
references: Chest. 2003 Sep;124(3):936-41
references: 12970020
references: Chest. 2014 Feb;145(2):322-30
references: 24178625