Abstract 14583: Sleep Apnea is Associated with Elevated High Sensitivity Troponin T in an Asymptomatic Community Dwelling Cohort: Data from the NHLBI ARIC-SHHS Study

Abstract

Background: Obstructive sleep apnea (OSA) is associated with heart failure (HF) and death. We hypothesized that among asymptomatic persons, severity of OSA measured by the respiratory disturbance index (RDI) is associated with higher levels of high sensitivity troponin T (hsTnT), reflecting cardiac stress and subclinical injury.

Methods: Overnight polysomnography and hsTnT were measured in 1,655 persons without prevalent cardiovascular disease participating in both the Sleep Heart Health and Atherosclerosis Risk in Communities studies. OSA severity was defined using established clinical categories -none (RDI≤5), mild (RDI 5-15), moderate (RDI 15-30), and severe (RDI>30). HsTnT was divided into five categories. The association between RDI and hsTnT was assessed using multivariable ordered logistic regression. Median follow-up was 12.3 years. The association of hsTnT and OSA with the composite HF or cardiovascular death (death/HF) was assessed by Cox proportional hazard regression.

Results: Average age was 62.5 ± 5.5 years and 54% were women. Greater severity of OSA was independently associated with higher hsTnT even after adjustment for 15 baseline demographic and clinical covariates (Figure A; p=0.038), an association driven by the severe OSA category. In multivariable analysis, hsTnT effectively discriminated risk of death/HF in all OSA categories (p≤0.008 in each category) and was associated with greater risk in more severe OSA (Figure B; p for interaction = 0.06).

Conclusion: OSA severity measured by RDI is associated with higher levels of hsTnT. Increased myocardial stress and subclinical injury may partially mediate the higher risk of HF associated with OSA. Elevated hsTnT may help identify those individuals with OSA at greatest risk for death/HF.