title: Racial/ethnic differences in the associations between obesity measures and severity of sleep-disordered breathing: the Multi-Ethnic Study of Atherosclerosis.
abstract: The objective of this study was to evaluate associations between obesity measures and sleep-disordered breathing severity among White, Black, Hispanic, and Chinese Americans.
  
  
  
  The method used in this study was a community-based cross-sectional study of 2053 racially/ethnically diverse adults in the Multi-Ethnic Study of Atherosclerosis. Anthropometry and polysomnography were used to measure obesity and apnea-hypopnea index (AHI). Linear regression models were fitted to investigate associations of body mass index (BMI) and waist circumference with AHI (log transformed) with adjustment for sociodemographics, lifestyle factors, and comorbidities.
  
  
  
  The mean participant age was 68.4 (range: 54-93) years; 53.6% of participants were women. The median AHI was 9.1 events/h. There were significant associations of BMI and waist circumference with AHI in the overall cohort and within each racial/ethnic group. A significant interaction was observed between race/ethnicity and BMI (Pinteraction= 0.017). Models predicted that for each unit increase in BMI (kg/m2), the mean AHI increased by 19.7% for Chinese, 11.6% for Whites and Blacks, and 10.5% for Hispanics. Similarly, incremental changes in waist circumference were associated with larger increases in AHI among Chinese than among other groups.
  
  
  
  Associations of BMI and waist circumference with AHI were stronger among Chinese than among other racial/ethnic groups. These findings highlight a potential emergence of elevated sleep-disordered breathing prevalence occurring in association with increasing obesity in Asian populations.
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA. Electronic address: xchen@hsph.harvard.edu.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Medicine, Harvard Medical School; Brigham and Women's Hospital, Boston, MA 02115, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: Division of Epidemiology, Community Health University of Minnesota, Minneapolis, MN 55454, USA.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Lutsey
authors.affiliation: Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Zee
authors.affiliation: Department of Medicine, Harvard Medical School; Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Sogol
authors.initials: S
authors.lastname: Javaheri
authors.affiliation: Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: Carmela
authors.initials: C
authors.lastname: Alcántara
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Harvard Catalyst, Clinical and Translational Science Center, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Chandra L
authors.initials: CL
authors.lastname: Jackson
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, MD 21224, USA.
authors.forename: Naresh
authors.initials: N
authors.lastname: Punjabi
authors.affiliation: Department of Medicine, Harvard Medical School; Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Williams
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001213:Asian / Q000706:statistics & numerical data; D050197:Atherosclerosis / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D015992:Body Mass Index; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D017286:Polysomnography / Q000379:methods; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
keywords: Apnea–hypopnea index; Body mass index; Obesity; Polysomnography; Race/ethnicity; Sleep-disordered breathing; Waist circumference