Relation of sleep-disordered breathing to carotid plaque and intima-media thickness

doi:10.1016/j.atherosclerosis.2007.02.029

Atherosclerosis

Volume 197, Issue 1, March 2008, Pages 125-131

https://doi.org/10.1016/j.atherosclerosis.2007.02.029 Get rights and content

Abstract

Background

Sleep-disordered breathing (SDB) is associated with clinical cardiovascular disease (CVD), but its relation to subclinical atherosclerosis remains to be determined.

Methods

We analyzed the cross-sectional associations of SDB, measured by the respiratory disturbance index (RDI), a hypoxemia index, and an arousal index, with carotid plaque and carotid intima-media thickness (IMT), measured by ultrasound. The sample included 985 participants in the Sleep Heart Health Study (mean age—62, median RDI—8.7) with no history of coronary heart disease and stroke, of whom 396 had evidence of a carotid plaque.

Results

As compared with the first quartile of the RDI (0–1.2), the crude odds ratio for carotid plaque was 1.14, 1.27, and 1.48 for the second (1.3–4.1), third (4.2–10.7), and fourth (>10.7) quartile, respectively. After adjustment for CVD risk factors, the corresponding odds ratios were reduced (1.00, 1.04, 1.07, and 1.25). Similarly, the unadjusted mean carotid IMT increased with RDI, but adjusted means (mm) were similar (0.84, 0.85, 0.84, 0.85). Spline regression models did not show monotonicity of the dose–response functions at the right end of the RDI distribution. Neither the hypoxemia index nor the arousal index was associated with carotid plaque or carotid IMT.

Conclusion

The results of this study suggest that crude, positive associations between SDB and subclinical atherosclerosis can be attributed to confounding by CVD risk factors.

Section snippets

Study population

The aims and design of the SHHS have been reported in detail [10]. Briefly, between November 1995 and January 1998, SHHS participants were recruited from several ongoing population-based studies of cardiovascular or respiratory disease. The SHHS cohort comprised 6441 subjects who did not use continuous positive airway pressure, and were not treated with supplemental oxygen. B-mode carotid ultrasound measurements were available from a subset of 1236 SHHS subjects who were recruited from two

Results

The distributions of SDB indices were skewed to the right. The median value of the RDI was 8.7 events/h, and the interquartile range (25th percentile and 75th percentile) was 1.3–10.8 events/h. The 25th, 50th, and 75th percentiles of the hypoxemia index were 0.0%, 0.2%, and 1.6% of total sleep time, respectively; the corresponding values for the arousal index were 12.4, 16.9, and 24.1 events/h.

Table 1 presents characteristics of the participants by the presence or absence of carotid plaque and

Discussion

In this community-based sample of 985 middle-aged men and women, SDB, as assessed by the RDI, degree of nocturnal hypoxemia, and frequency of arousals, was modestly and positively associated with carotid plaques and carotid IMT in models with no covariates. However, after adjustment for CVD risk factors, we found no evidence of meaningful associations of SDB indices with carotid plaques or carotid IMT, implying confounded crude associations.

A growing body of evidence suggests that SDB is

Acknowledgments

The SHHS acknowledges the Atherosclerosis Risk in Communities Study, the Cardiovascular Health Study, the Framingham Heart Study, the Cornell/Mt Sinai Worksite and Hypertension Studies, the Strong Heart Study, the Tucson Epidemiologic Study of Airways Obstructive Diseases, and the Tucson Health and Environment Study for allowing their cohort members to be part of the SHHS and for permitting data acquired by them to be used in the study. The SHHS is particularly grateful to the members of these

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^☆: This study was supported by National Heart, Lung and Blood Institute cooperative agreements U01 HL53940 (University of Washington, Seattle), U01 HL53941 (Boston University), U01 HL53938 (University of Arizona, Tucson), U01 HL53916 (University of California, Davis), U01 HL53934 (University of Minnesota, Minneapolis), U01 HL53931 (New York University, New York), U01 HL53937 and U01 HL64360 (The Johns Hopkins University, Baltimore, MD), U01 HL63463 (Case Western Reserve University, Cleveland, Ohio), and U01 HL63429 (Missouri Breaks Industries Research, Inc., Timber Lake, SD), and cooperative agreement supplement HL53938-07S1 (University of Arizona).

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Relation of sleep-disordered breathing to carotid plaque and intima-media thickness☆

Abstract

Background

Methods

Results

Conclusion

Section snippets

Study population

Results

Discussion

Acknowledgments

Chest

Atherosclerosis

Chest

Respiratory disturbance index: an independent predictor of mortality in coronary artery disease

Am J Respir Crit Care Med

Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure

Am J Respir Crit Care Med

Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study

Am J Respir Crit Care Med

Obstructive sleep apnea: implications for cardiac and vascular disease

JAMA

Is there a link between the severity of sleep-disordered breathing and atherosclerotic disease of the carotid arteries?

Eur J Neurol

Evaluation of carotid artery wall thickness with high-resolution sonography in obstructive sleep apnea syndrome

J Clin Ultrasound

The Sleep Heart Health Study: design, rationale, and methods

Sleep

The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators

Am J Epidemiol

Methods for obtaining and analyzing unattended polysomnography data for a multicenter study. Sleep Heart Health Research Group

Sleep