Abstract
STUDY OBJECTIVES: Evaluate the association between obstructive sleep apnea (OSA), coronary artery calcium (CAC) density, and cardiovascular events in the Multi-Ethnic Study of Atherosclerosis (MESA).
METHODS: We analyzed 1041 participants with non-zero CAC scores who had polysomnography and CAC density data from the fifth examination of MESA. OSA was defined as apnea-hypopnea index [AHI] ≥ 15 events/hour. Multivariable linear regression models were used to evaluate the independent association between OSA and CAC density. Additionally, we evaluated the impact of OSA on associations of CAC measures with incident CVD events by testing for interaction in Cox proportional hazard regression models.
RESULTS: Our analytical sample was 45% female with a mean age of 70.6 +/- 9 years. Of this sample, 36.7% (n=383/1041) had OSA (AHI≥15). OSA was inversely and weakly associated with CAC density (β= -0.09, 95% CI -0.17 to -0.02, p=0.014) and remained significantly associated after controlling for traditional cardiovascular risk factors (β= -0.08, 95% CI -0.16 to 0, p=0.043). However, this inverse association was attenuated after controlling for BMI (β=-0.05, 95% CI -0.13 to 0.02, p=0.174). The mean follow-up period for CVD events was 13.3 +/- 2.8 years. Additionally, exploratory analysis demonstrated that CAC density was independently and inversely associated with CVD events only in the non-OSA subgroup (AHI≤15) (HR 0.509 [CI 0.323 - 0.801], p=0.0035).
CONCLUSIONS: OSA was associated with lower CAC density, but this association was attenuated by BMI. Further, increased CAC density was associated with a reduced risk of CVD events only in individuals within the non-OSA group in exploratory analysis.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2075-2083 |
| Number of pages | 9 |
| Journal | Journal of Clinical Sleep Medicine |
| Volume | 17 |
| Issue number | 10 |
| Early online date | May 14 2021 |
| DOIs | |
| State | Published - Oct 1 2021 |
Bibliographical note
Funding Information:All authors have seen and approved the current version of the manuscript. Work was performed at the Icahn School of Medicine at Mount Sinai, New York, NY. This research was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR–000040, UL1-TR–001079, and UL1-TR–001420 from the National Center for Advancing Translational Sciences (NCATS). This publication was developed under the Science to Achieve Results (STAR) research assistance agreements, No. RD831697 (MESA Air) and RD-83830001 (MESA Air Next Stage), awarded by the US Environmental Protection Agency. It has not been formally reviewed by the EPA. The views expressed in this document are solely those of the authors and the EPA does not endorse any products or commercial services mentioned in this publication. S.B.N, V.K., M.M., M.R., J.R.K., R.C.K., Z.A.F., V.M., S.S., M.A., M.C., P.L.L., R.L.M., and N.A.S. report no conflicts of interest. S.R. reports receiving grants and consulting funds from Jazz Pharmaceuticals and consulting fees from Eisai Pharmaceuticals, unrelated to this project. J.R.K. reports stock ownership in Bristol Myers Squibb, Johnson & Johnson, Medtronic, Merck, and Pfizer.
Publisher Copyright:
© 2021 American Academy of Sleep Medicine.
Keywords
- Atherosclerosis
- Coronary artery calcium
- Sleep apnea
