title: Sleep Disordered Breathing in Four Resource-Limited Settings in Peru: Prevalence, Risk Factors, and Association with Chronic Diseases.
abstract: OBJECTIVE
  Sleep disordered breathing (SDB) is a highly prevalent condition in high-income countries, with major consequences for cardiopulmonary health, public safety, healthcare utilization, and mortality. However, its prevalence and effect in low- and middle-income countries are less well known. We sought to determine the prevalence, risk factors, and comorbidities of SDB symptoms in four resource-limited settings.
  
  
  METHODS
  Cross-sectional analysis of the CRONICAS Cohort, a population-based age- and sex-stratified sample.
  
  
  METHODS
  Four resource-limited settings in Peru varying in altitude, urbanization, and air pollution.
  
  
  METHODS
  There were 2,682 adults aged 35 to 92 y.
  
  
  RESULTS
  Self-reported SDB symptoms (habitual snoring, observed apneas, Epworth Sleepiness Scale), sociodemographics, medical history, anthropometrics, spirometry, blood biomarkers were reported. We found a high prevalence of habitual snoring (30.2%, 95% confidence interval [CI] 28.5-32.0%), observed apneas (20.9%, 95% CI 19.4-22.5%) and excessive daytime sleepiness (18.6%, 95% CI 17.1-20.1%). SDB symptoms varied across sites; prevalence and adjusted odds for habitual snoring were greatest at sea level, whereas those for observed apneas were greatest at high altitude. In multivariable analysis, habitual snoring was associated with older age, male sex, body mass index (BMI), and higher socioeconomic status; observed apneas were associated with BMI; and excessive daytime sleepiness was associated with older age, female sex, and medium socioeconomic status. Adjusted odds of cardiovascular disease, depression, and hypertension and total chronic disease burden increased progressively with the number of SDB symptoms. A threefold increase in the odds of having an additional chronic comorbid disease (adjusted odds ratio 3.57, 95% CI 2.18-5.84) was observed in those with all three versus no SDB symptoms.
  
  
  CONCLUSIONS
  Sleep disordered breathing symptoms were highly prevalent, varied widely across four resource-limited settings in Peru, and exhibited strong independent associations with chronic diseases.
authors.affiliation: Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD.|Pritzker School of Medicine, University of Chicago, Chicago, IL.
authors.forename: Noah G
authors.initials: NG
authors.lastname: Schwartz
authors.affiliation: Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Adi
authors.initials: A
authors.lastname: Rattner
authors.affiliation: Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Schwartz
authors.affiliation: Pritzker School of Medicine, University of Chicago, Chicago, IL.
authors.forename: Babak
authors.initials: B
authors.lastname: Mokhlesi
authors.affiliation: Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.affiliation: CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bernabe-Ortiz
authors.affiliation: CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.|Departamento de Medicina, Escuela de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Miranda
authors.affiliation: Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD.|Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
authors.forename: William
authors.initials: W
authors.lastname: Checkley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000397:Air Pollution / Q000706:statistics & numerical data; D000531:Altitude; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D006295:Health Resources; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012727:Sex Characteristics; D012891:Sleep Apnea Syndromes / Q000453:epidemiology*; D012894:Sleep Stages; D012913:Snoring / Q000453:epidemiology; D012923:Social Class; D014507:Urbanization
keywords: chronic diseases; population-based study; sleep disordered breathing
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