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Am. J. Respir. Crit. Care Med., Volume 163, Number 1, January 2001, 19-25

Sleep-disordered Breathing and Cardiovascular Disease
Cross-sectional Results of the Sleep Heart Health Study

EYAL SHAHAR, CORALYN W. WHITNEY, SUSAN REDLINE, ELISA T. LEE, ANNE B. NEWMAN, F. JAVIER NIETO, GEORGE T. O'CONNOR, LORI L. BOLAND, JOSEPH E. SCHWARTZ, and JONATHAN M. SAMET, for the Sleep Heart Health Study Research Group

Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Department of Biostatistics, University of Washington, Seattle, Washington; Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio; Center for American Indian Health Research, University of Oklahoma, Oklahoma City, Oklahoma; Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; and Department of Psychiatry, State University of New York, Stony Brook, New York

Disordered breathing during sleep is associated with acute, unfavorable effects on cardiovascular physiology, but few studies have examined its postulated association with cardiovascular disease (CVD). We examined the cross-sectional association between sleep- disordered breathing and self-reported CVD in 6,424 free-living individuals who underwent overnight, unattended polysomnography at home. Sleep-disordered breathing was quantified by the apnea-hypopnea index (AHI)---the average number of apneas and hypopneas per hour of sleep. Mild to moderate disordered breathing during sleep was highly prevalent in the sample (median AHI: 4.4; interquartile range: 1.3 to 11.0). A total of 1,023 participants (16%) reported at least one manifestation of CVD (myocardial infarction, angina, coronary revascularization procedure, heart failure, or stroke). The multivariable-adjusted relative odds (95% CI) of prevalent CVD for the second, third, and fourth quartiles of the AHI (versus the first) were 0.98 (0.77-1.24), 1.28 (1.02-1.61), and 1.42 (1.13-1.78), respectively. Sleep-disordered breathing was associated more strongly with self-reported heart failure and stroke than with self-reported coronary heart disease: the relative odds (95% CI) of heart failure, stroke, and coronary heart disease (upper versus lower AHI quartile) were 2.38 (1.22-4.62), 1.58 (1.02- 2.46), and 1.27 (0.99-1.62), respectively. These findings are compatible with modest to moderate effects of sleep-disordered breathing on heterogeneous manifestations of CVD within a range of AHI values that are considered normal or only mildly elevated.




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