Sleep apnea is associated with subclinical myocardial injury in the community. The ARIC-SHHS study

Abstract

Rationale: Obstructive sleep apnea (OSA) is associated with cardiovascular morbidity and mortality, although the underlying mechanisms are not well understood.

Objectives: We aimed to determine whether more severe OSA, measured by the Respiratory Disturbance Index (RDI), is associated with subclinical myocardial injury and increased myocardial wall stress.

Methods: A total of 1,645 participants (62.5 ± 5.5 yr and 54% women) free of coronary heart disease and heart failure and participating in both the Atherosclerosis Risk in the Communities and the Sleep Heart Health Studies underwent overnight polysomnography and measurement of high-sensitivity troponin T (hs-TnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP).

Measurements and main results: OSA severity was defined using conventional clinical categories: none (RDI ≤ 5), mild (RDI 5-15), moderate (RDI 15-30), and severe (RDI > 30). Hs-TnT, but not NT-proBNP, was associated with OSA after adjusting for 17 potential confounders (P = 0.02). Over a median of 12.4 (interquartile range, 11.6-13.1) years follow-up, hs-TnT was related to risk of death or incident heart failure in all OSA categories (P ≤ 0.05 in each category).

Conclusions: In middle-aged to older individuals, OSA severity is independently associated with higher levels of hs-TnT, suggesting that subclinical myocardial injury may play a role in the association between OSA and risk of heart failure. OSA was not associated with NT-proBNP levels after adjusting for multiple possible confounders.

Figure 1.

Whisker box-plot of high-sensitivity troponin T (hs-TnT) levels by obstructive sleep apnea (OSA) category. Hs-TnT is shown using a logarithmic scale. Values under the limit of detection (0.003 μg/L) are assigned to a value of 0.002 μg/L). *Unadjusted ordinal logistic regression. ^†Multivariable ordinal logistic regression adjusted by age, body mass index, smoking status, alcohol intake, hypertension, diabetes, chronic lung disease, pulmonary function tests, estimated glomerular filtration rate, systolic blood pressure, and blood levels of total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, and insulin (Model 5).