Sleep-disordered breathing and cardiovascular disease: Cross-sectional results of the sleep heart health study

Disordered breathing during sleep is associated with acute, unfavorable eff ects on cardiovascular physiology, but few studies have examined its postul ated association with cardiovascular disease (CVD). We examined the cross-s ectional association between sleep-disordered breathing and self-reported C VD in 6,424 free-living individuals who underwent overnight, unattended pol ysomnography at home. Sleep-disordered breathing was quantified by the apne a-hypopnea index (AHI)-the average number 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 1,02 3 participants (16%) reported at least one manifestation of CVD (myocardial infarction, angina, coronary revascularization procedure, heart failure, o r stroke). The multivariable-adjusted relative odds (95% CI) of prevalent C VD 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), respective ly. Sleep-disordered breathing was associated more strongly with self-repor ted heart failure and stroke than with self-reported coronary heart disease : the relative odds (95% CI) of heart failure, stroke, and coronary heart d isease (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 wi th modest to moderate effects of sleep-disordered breathing on heterogeneou s manifestations of CVD within a range of AHI values that are considered no rmal or only mildly elevated.