Association between diet quality and sleep apnea in the Multi-Ethnic Study of Atherosclerosis

Michelle Reid, Janice E. Maras, Steven Shea, Alexis C. Wood, Cecilia Castro-Diehl, Dayna A. Johnson, Tianyi Huang, David R. Jacobs, Allison Crawford, Marie Pierre St-Onge, Susan Redline

Research output: Contribution to journalArticlepeer-review

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Rationale Although short sleep duration has been linked to unhealthy dietary patterns, little is known about the association of obstructive sleep apnea (OSA), a disorder characterized by sleep fragmentation and diet. Study Objectives Investigate associations between diet quality and OSA in the Multi-Ethnic Study of Atherosclerosis and assess whether reductions in slow-wave sleep (stage N3) and rapid eye movement (REM) sleep are potential mediators for these associations. Methods A diverse population (N = 1813) completed a food frequency questionnaire and underwent Type 2 in-home polysomnography, which included measurement of N3 and REM sleep and apnea-hypopnea index (AHI). Moderate-to-more severe OSA was defined as having an AHI > 15 events/hr. Results Participants were 53.9% female with a mean age of 68.3 (SD 9.1) years. Approximately 33.8% were categorized as having moderate-to-more severe OSA. In adjusted analyses, OSA was associated with lower intakes of whole grains, (β = -0.200, SE = 0.072, p < 0.01), higher intakes of red/processed meat, (β = -0.440, SE = 0.136, p < 0.01), and lower overall diet quality (β = -1.286, SE = 0.535, p = 0.02). Stage N3 sleep partially explained the associations between red/processed meat and overall diet quality score with OSA. Conclusions Moderate-to-more severe OSA is associated with a less healthy dietary profile that is partially explained by reduced N3 sleep. These findings suggest the opportunity to target sleep quality in interventions aimed at improving cardio-metabolic risk factors in patients with OSA.

Original languageEnglish (US)
Article numberzsy194
Issue number1
StatePublished - Jan 1 2019

Bibliographical note

Funding Information:
MESA is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with MESA investigators. Support for MESA is provided by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169, UL1-TR-000040, UL1-TR-001079, UL1-TR-001881, and DK06349. Funding support for the Sleep Polysomnography dataset was provided by grant HL56984. A full list of participating MESA investigators and institutions can be found at http:// The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health. Dr. Susan Redline is partly funded through the NHLBI (1R35 HL135818-01). Drs. Johnson-Morgan and Redline reports grants from NIH, during the conduct of this study. Dr. Shea reports grants from NHLBI, during the conduct of the study. Dr. St-Onge reports grants from NHLBI and the American Heart Association Go Red for Women Strategically Focused Research Network during the conduct of this study.

Publisher Copyright:
© 2018 Sleep Research Society.


  • Alternative Health Eating Index
  • OSA
  • diet quality
  • slow-wave sleep
  • Humans
  • Risk Factors
  • Male
  • Sleep Apnea, Obstructive/physiopathology
  • Polysomnography
  • Sleep, REM/physiology
  • Diet, Healthy/statistics & numerical data
  • Ethnic Groups
  • Female
  • Aged
  • Atherosclerosis/pathology
  • Health Status
  • Meat/statistics & numerical data
  • Sleep, Slow-Wave/physiology

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article
  • Research Support, N.I.H., Extramural


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