TitleCoronary heart disease incidence in sleep disordered breathing: the Wisconsin Sleep Cohort Study.
Publication TypeJournal Article
Year of Publication2015
AuthorsHla, KMae, Young, T, Hagen, EW, Stein, JH, Finn, LA, F. Nieto, J, Peppard, PE
Date Published2015 May 01
KeywordsCohort Studies, Comorbidity, Coronary Disease, Female, Follow-Up Studies, Heart Failure, Humans, Incidence, Male, Middle Aged, Myocardial Infarction, Polysomnography, Residence Characteristics, Sleep Apnea Syndromes, Survival Analysis, Wisconsin

STUDY OBJECTIVES: The aim of the study was to determine the association of objectively measured sleep disordered breathing (SDB) with incident coronary heart disease (CHD) or heart failure (HF) in a nonclinical population.

DESIGN: Longitudinal analysis of a community-dwelling cohort followed up to 24 y.

SETTING: Sleep laboratory at the Clinical Research Unit of the University of Wisconsin Hospital and Clinics.

PARTICIPANTS: There were 1,131 adults who completed one or more overnight polysomnography studies, were free of CHD or HF at baseline, were not treated by continuous positive airway pressure (CPAP), and followed over 24 y.


MEASUREMENTS AND RESULTS: In-laboratory overnight polysomnography was used to assess SDB, defined by the apnea-hypopnea index (AHI) using apnea and hypopnea events per hour of sleep. Incident CHD or HF was defined by new reports of myocardial infarction, coronary revascularization procedures, congestive heart failure, and cardiovascular deaths. We used baseline AHI as the predictor variable in survival analysis models predicting CHD or HF incidence adjusted for traditional confounders. The incidence of CHD or HF was 10.9/1,000 person-years. The mean time to event was 11.2 ± 5.8 y. After adjusting for age, sex, body mass index, and smoking, estimated hazard ratios (95% confidence interval) of incident CHD or HF were 1.5 (0.9-2.6) for AHI > 0-5, 1.9 (1.05-3.5) for AHI 5 ≤ 15, 1.8 (0.85-4.0) for AHI 15 ≤ 30, and 2.6 (1.1-6.1) for AHI > 30 compared to AHI = 0 (P trend = 0.02).

CONCLUSIONS: Participants with untreated severe sleep disordered breathing (AHI > 30) were 2.6 times more likely to have an incident coronary heart disease or heart failure compared to those without sleep disordered breathing. Our findings support the postulated adverse effects of sleep disordered breathing on coronary heart disease and heart failure.

Alternate JournalSleep
PubMed ID25515104
PubMed Central IDPMC4402672
Grant ListUL1 TR000427 / TR / NCATS NIH HHS / United States
1R01AG036838 / AG / NIA NIH HHS / United States
R01AG14124 / AG / NIA NIH HHS / United States
R01HL62252 / HL / NHLBI NIH HHS / United States
1UL1RR025011 / RR / NCRR NIH HHS / United States