title: Obstructive sleep apnea is independently associated with subclinical coronary atherosclerosis among middle-aged women.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) is associated with coronary disease among men. However, this association is not clear for women. In this study, we evaluate the association between OSA and presence of subclinical atherosclerosis assessed by tomographic coronary calcium score in middle-aged women.
  
  
  METHODS
  We evaluated consecutive women aged between 45 and 65 years in perimenopause or postmenopause period (with menstrual irregularity-amenorrhea > 60 days), without manifest cardiovascular disease (heart failure, coronary disease, and stroke), from two gynecologic clinics. All patients underwent clinical evaluation, computed tomographic examination for coronary artery calcium (CAC > 100 Agatston units), and portable sleep study. Multiple logistic regression models were used to evaluate the association between OSA and CAC, controlling for traditional risk factors including Framingham Risk Score (FRS), body mass index (BMI), and diabetes.
  
  
  RESULTS
  We studied 214 women (age 56 years (52-61); BMI 28 kg/m2(25-31), 25 % diabetes, 62 % hypertension). OSA (apnea-hypopnea index (AHI) ≥5 events/h) was diagnosed in 82 women (38.3 %). CAC was more prevalent in patients with moderate/severe OSA (AHI ≥15 events/h) than in patients without or with mild OSA, 19 % vs 4.5 and 1.6 %, respectively (p < 0.01). Moderate to severe OSA was associated with CAC in unadjusted (odds ratio = 6.25, 95 % CI 1.66-23.52; p < 0.01) and adjusted (odds ratio = 8.19, 95 % CI 1.66-40.32; p = 0.01) logistic regression analysis.
  
  
  CONCLUSIONS
  Moderate to severe OSA is independently associated with the presence of CAC in middle-aged women. These results reinforce the concept that women are also susceptible to the cardiovascular consequences of OSA.
authors.affiliation: Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, Recife, Pernambuclo, Brazil.
authors.forename: Ana Kelley L
authors.initials: AK
authors.lastname: Medeiros
authors.affiliation: Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Pernambuclo, Brazil.
authors.forename: Ricardo Q
authors.initials: RQ
authors.lastname: Coutinho
authors.affiliation: Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Pernambuclo, Brazil.
authors.forename: Isly M L
authors.initials: IM
authors.lastname: Barros
authors.affiliation: Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Pernambuclo, Brazil.
authors.forename: Laura O B F
authors.initials: LO
authors.lastname: Costa
authors.affiliation: Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Pernambuclo, Brazil.
authors.forename: Ana Paula D L
authors.initials: AP
authors.lastname: Leite
authors.affiliation: University Hospital, University of São Paulo, São Paulo, Brazil.|Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Marcio S
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, Recife, Pernambuclo, Brazil.
authors.forename: Thais C
authors.initials: TC
authors.lastname: Lustosa
authors.affiliation: Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, Recife, Pernambuclo, Brazil.
authors.forename: Martinha M B
authors.initials: MM
authors.lastname: Carvalho
authors.affiliation: Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, Recife, Pernambuclo, Brazil.
authors.forename: Maria Priscila Figueiredo
authors.initials: MP
authors.lastname: Lira
authors.affiliation: Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Pernambuclo, Brazil.
authors.forename: Moacir N L
authors.initials: MN
authors.lastname: Ferreira
authors.affiliation: Sleep Laboratory, Pulmonary Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Geraldo
authors.initials: G
authors.lastname: Lorenzi-Filho
authors.affiliation: Hypertension Unit, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Luciano F
authors.initials: LF
authors.lastname: Drager
authors.affiliation: Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, Recife, Pernambuclo, Brazil. rppedrosa@terra.com.br.|Hypertension Unit, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. rppedrosa@terra.com.br.|Hospital Metropolitano Sul Dom Helder Câmara-IMIP Hospitalar, Cabo de Santo Agostinho, Brazil. rppedrosa@terra.com.br.
authors.forename: Rodrigo P
authors.initials: RP
authors.lastname: Pedrosa
mesh_terms: D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D050177:Overweight / Q000175:diagnosis / Q000503:physiopathology; D012307:Risk Factors; D064586:Selenic Acid; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D013223:Statistics as Topic; D061205:Vascular Calcification / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D064586:Selenic Acid
keywords: Atherosclerosis; Coronary heart disease; Obstructive sleep apnea; Women