title: Association of sleep apnea and sleep duration with peripheral artery disease: The Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: Numerous biological pathways linking sleep disturbances to atherosclerosis have been identified, such as insulin resistance, inflammation, hypertension, and endothelial dysfunction. Yet, the association of sleep apnea and sleep duration with peripheral artery disease (PAD) is not well characterized.
  
  
  
  We evaluated the cross-sectional association between objectively measured sleep and prevalent PAD in 1844 participants (mean age 68 years) who in 2010-2013 had in-home polysomnography, 7-day wrist actigraphy and ankle-brachial index (ABI) measurements. We also evaluated the relation between self-reported diagnosed sleep apnea and PAD incidence in 5365 participants followed from 2000 to 2012. PAD was defined as ABI < 0.90.
  
  
  
  In cross-sectional analyses, severe sleep apnea [apnea-hypopnea index (AHI) ≥30 vs. AHI <5] was associated with greater prevalent PAD only among black participants [multivariate adjusted prevalence ratio (95% CI): 2.29 (1.07-4.89); p-interaction = 0.05]. Short and long sleep duration was also associated with a 2-fold higher prevalence of PAD as compared with those who slept 7 h/night, in the full sample. In longitudinal analyses, participants with self-reported diagnosed sleep apnea were at higher risk of incident PAD [multivariable adjusted hazard ratio (95% CI): 1.93 (1.05-3.53)], with no evidence of interaction by race/ethnicity.
  
  
  
  These findings support a significant association between sleep apnea and prevalent and incident PAD, with evidence for stronger associations with objectively measured sleep apnea and cross sectional PAD in blacks. In addition, short and long sleep duration was associated with PAD. These results identify sleep disturbances as a potential risk factor for PAD.
authors.affiliation: Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan. Electronic address: mnagayoshi@nagasaki-u.ac.jp.
authors.forename: Mako
authors.initials: M
authors.lastname: Nagayoshi
authors.affiliation: Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Lutsey
authors.affiliation: Division of Biostatistics, University of California, Berkeley, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Benkeser
authors.affiliation: Department of Pathology and Laboratory Medicine, College of Medicine, University of Vermont, Colchester, VT, USA.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Wassel
authors.affiliation: Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.affiliation: Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
authors.forename: Eyal
authors.initials: E
authors.lastname: Shahar
authors.affiliation: Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
authors.affiliation: Department of Family Medicine and Public Health, University of California, San Diego, CA, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Allison
authors.affiliation: Department of Family Medicine and Public Health, University of California, San Diego, CA, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.affiliation: Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000208:ethnology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D058729:Peripheral Arterial Disease / Q000097:blood / Q000150:complications* / Q000208:ethnology; D015995:Prevalence; D012307:Risk Factors; D057566:Self Report; D012720:Severity of Illness Index; D012890:Sleep; D012891:Sleep Apnea Syndromes / Q000097:blood / Q000150:complications*
keywords: Community-based study; Epidemiology; Longitudinal study; Obstructive sleep apnea; Peripheral artery disease; Sleep duration