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Observational Study
. 2016 Mar:19:69-74.
doi: 10.1016/j.sleep.2015.11.009. Epub 2015 Nov 27.

The association between sleep-disordered breathing and aortic stiffness in a community cohort

Hassan A Chami  1 , Ramachandran S Vasan  2 , Martin G Larson  3 , Emelia J Benjamin  2 , Gary F Mitchell  4 , Daniel J Gottlieb  5
Affiliations
Observational Study

The association between sleep-disordered breathing and aortic stiffness in a community cohort

Hassan A Chami et al. Sleep Med. 2016 Mar.

Abstract

Objective: Sleep-disordered breathing is associated with hypertension and cardiovascular disease. Increased aortic stiffness is one possible linking mechanism. We evaluated the association between sleep-disordered breathing and aortic stiffness in a community-based sample.

Methods: Our community-based cross-sectional observational study included 381 participants from the Framingham Heart Study (55% women, mean age 58.0 S.D. = 9.4 years, 51% ethnic minorities). Polysomnographically derived apnea-hypopnea index and CT90% (cumulative % sleep time with oxyhemoglobin saturation <90%) quantified sleep-disordered breathing severity. Carotid-femoral pulse wave velocity, the gold-standard measure of aortic stiffness, was calculated using arterial applanation tonometry-derived waveforms and body surface measured transit distance. We assessed associations between sleep-disordered breathing and carotid-femoral pulse wave velocity using multivariable regression. We adjusted for age, sex, race, body mass index, diabetes, alcohol consumption, hormone replacement therapy, cholesterol/high-density lipoprotein, lipid-lowering therapy, anti-hypertensive medication, smoking, hypertension, and prevalent cardiovascular disease.

Results: After multivariable adjustment, carotid-femoral pulse wave velocity was associated with both apnea-hypopnea index (β = 0.03, 95% CI: 0.002-0.07, p= 0.04) and CT90% (β = 0.05, 95% CI: 0.005-0.1, p= 0.03). The adjusted mean carotid-femoral pulse wave velocity was 9.43 (95% CI: 9.12-9.74), 9.76 (95% CI: 9.25-10.26), and 10.15 (95% CI: 9.37-10.92) m/s, respectively, in subjects with apnea-hypopnea index <5, 5-14.9, and ≥15 events/h.

Conclusions: In a community-based sample of middle aged and older men and women, sleep-disordered breathing was associated with increased carotid-femoral pulse wave velocity, a strong predictor of cardiovascular risk.

Keywords: Aortic stiffness; Epidemiology; Sleep apnea.

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Conflict of interest statement

Conflicts of Interest: RSV, MGL and DJG reported no conflicts of interest related to this work.

Figures

Fig. 1
Fig. 1
Mean adjusted carotid-femoral pulse wave velocity (CFPMV) by apnea–hypopnea index (AHI) category. Demographic model: Adjusts for age, sex and race. Multivariable model: further adjusts for body mass index, hormone-replacement therapy, alcohol consumption, cigarette smoking, total serum cholesterol/high-density lipoprotein ratio, diabetes, and lipid-lowering and antihypertensive therapy. Multivariable + CVD model further adjusts for prevalent hypertension and cardiovascular disease (coronary heart disease, congestive heart failure, stroke, transient ischemic attacks, and claudication).
Fig. 2
Fig. 2
Mean adjusted carotid-femoral pulse wave velocity (CFPMV) by hypoxemia index category. Demographic model: adjusts for age, sex and race. Multivariable model: further adjusts for body mass index, hormone-replacement therapy, alcohol consumption, cigarette smoking, total serum cholesterol/high-density lipoprotein ratio, diabetes, and lipid-lowering and antihypertensive therapy. Multivariable + CVD model further adjusts for prevalent hypertension and cardiovascular disease (coronary heart disease, congestive heart failure, stroke, transient ischemic attacks and claudication).
See this image and copyright information in PMC

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