Abstract 10171: Longitudinal Association of Sleep-Disordered Breathing With Subclinical Carotid Artery Disease: Thirteen-year Follow-up From the Wisconsin Sleep Cohort
Background: Carotid artery intima-media thickness (IMT) and plaque (CP) presence are markers of subclinical arterial injury and atherosclerosis that indicate increased cardiovascular disease risk. The association between sleep-disordered breathing (SDB) and carotid IMT is based on findings from relatively small cross-sectional studies. We evaluated longitudinal associations between SDB and subclinical carotid artery disease in the Wisconsin Sleep Cohort, a large population-based cohort investigating the health effects of SDB.
METHODS: Participants had a baseline overnight polysomnogram between 1989 and 2004 and had a subsequent carotid ultrasound study a mean of 13.4 (standard deviation 3.4) years later. SDB was characterized by the apnea-hypopnea index (AHI, events/hr). High-resolution B-mode ultrasound studies of the right and left common, bulb, and internal carotid artery segments were interpreted by a single experienced reader. CP was identified from all segments. Mean and maximum far wall IMT were measured in both common carotid arteries. Multivariable linear and logistic regression models were used to identify the independent contributions of baseline AHI to subsequent IMT and CP presence. AHI was transformed as log10(AHI+1).
RESULTS: At baseline, the 774 participants were mean (standard deviation) 47.7 (7.7) years old (55% male, 97% white). They had a body-mass index (BMI) of 29.6 (6.0) kg/m2; 27% had hypertension. Mean-mean carotid IMT was 0.75 (0.16) mm; 61% had CP. Mean AHI was 4.3 (9.0) events/hour (range, 0.0-97.5); 57 (7.3%) had AHI>15 events/hr. After adjusting for age and sex, baseline AHI predicted later mean-mean and -max IMT (both p<0.001) and CP presence (p=0.003). In models adjusted for age, sex, BMI, smoking, systolic blood pressure, hypertension, lipid-lowering medication use and diabetes mellitus, AHI remained independently associated with mean-mean IMT (β=0.017 mm/log10(events/hr), p=0.040), mean-max IMT (β=0.024 mm/log10(events/hr), p=0.012), and CP presence (odds ratio 1.52 (95% confidence interval 0.99-2.35), p=0.057).
Conclusions: This is the first large, longitudinal study to demonstrate that prevalent SDB is independently associated with increased carotid IMT and CP presence over a decade later.
- © 2013 by American Heart Association, Inc.