Abstract P067: Longitudinal Association of Self-Reported Sleep-Disordered Breathing and Peripheral Arterial Disease: The Multi-Ethnic Study of Atherosclerosis
Background: Sleep-disordered breathing (SDB) has been associated with cardiovascular disease risk factors and event occurrence in previous studies. However, the association between SDB and peripheral arterial disease (PAD) is not well characterized.
Hypothesis: SDB is associated with greater risk of incident PAD.
Design: A total of 5,661 the Multi-Ethnic Study of Atherosclerosis (MESA) participants (mean age 61 years, 52% female) without prevalent PAD at baseline (2000-2002) were followed for incident PAD. A sleep questionnaire was administered at exam 2 (2002-2004), and participants were categorized as having physician diagnosed apnea, habitual snoring, or a normal sleep breathing pattern. Incident PAD was defined by ABI <0.9 at exam 3 (2004-2006) and/or exam 5 (2008-2010). Cox proportional hazards models were used.
Results: Of our analytic sample, 3.5% reported physician diagnosed sleep apnea, 22.7% habitual snoring, and 73.8% had a normal sleep breathing pattern (Table). Over a median follow-up of 9.2 years, 230 incident PAD cases occurred. Compared to participants without SDB, although those with physician diagnosed apnea were at greater risk of incident PAD after adjustment for demographics and behavioral risk factors [Hazard ratio (95% CI): 1.96 (1.08-3.54)], further adjustment for BMI attenuated the association [1.79 (0.98-3.27)]. No associations were observed for habitual snoring. As all participants with physician diagnosed apnea and incident PAD were obese, we conducted analyses restricted to participants who were obese (body mass index ≥30). The association between physician diagnosed apnea and incident PAD was seemingly stronger than for the full study sample [HR=3.17 (1.59-6.30) for Model 3], although the p-value was 0.14 for a SDB by BMI interaction term.
Conclusion: These data suggest that incident PAD is higher in individuals with sleep apnea, with associations strongest amongst obese individuals. Further studies using objectively assessed sleep apnea severity and incident PAD seem warranted.
Author Disclosures: M. Nagayoshi: None. S. Redline: None. A.R. Folsom: None. E. Shahar: None. H. Iso: None. C.L. Wassel: None. M.A. Allison: None. M.H. Criqui: None. P.L. Lutsey: None.
- © 2015 by American Heart Association, Inc.