@article {768, title = {The effects of age, sex, ethnicity, and sleep-disordered breathing on sleep architecture.}, journal = {Arch Intern Med}, volume = {164}, year = {2004}, month = {2004 Feb 23}, pages = {406-18}, abstract = {

BACKGROUND: Polysomnography is used to assess sleep quality and to gauge the functional effect of sleep disorders. Few population-based data are available to estimate the variation in sleep architecture across the population and the extent to which sleep-disordered breathing (SDB), a common health condition, contributes to poor sleep independent of other factors. The objective of this study was to describe the population variability in sleep quality and to quantify the independent associations with SDB.

METHODS: Cross-sectional analyses were performed on data from 2685 participants, aged 37 to 92 years, in a community-based multicenter cohort study. Dependent measures included the percentage time in each sleep stage, the arousal index, and sleep efficiency. Independent measures were age, sex, ethnicity, comorbidity status, and the respiratory disturbance index.

RESULTS: Lighter sleep was found in men relative to women and in American Indians and blacks relative to other ethnic groups. Increasing age was associated with impaired sleep in men, with less consistent associations in women. Notably, women had, on average, 106\% more slow wave sleep. Sleep-disordered breathing was associated with poorer sleep; however, these associations were generally smaller than associations with sex, ethnicity, and age. Current smokers had lighter sleep than ex-smokers or never smokers. Obesity had little effect on sleep.

CONCLUSIONS: Sleep architecture varies with sex, age, ethnicity, and SDB. Individual assessment of the effect of SDB on sleep quality needs to account for other host characteristics. Men, but not women, show evidence of poorer sleep with aging, suggesting important sex differences in sleep physiology.

}, keywords = {Adult, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Comorbidity, Female, Humans, Male, Middle Aged, Multivariate Analysis, Sex Factors, Sleep, Sleep Apnea Syndromes}, issn = {0003-9926}, doi = {10.1001/archinte.164.4.406}, author = {Redline, Susan and Kirchner, H Lester and Quan, Stuart F and Gottlieb, Daniel J and Kapur, Vishesh and Newman, Anne} } @article {882, title = {Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study.}, journal = {Am J Respir Crit Care Med}, volume = {173}, year = {2006}, month = {2006 Apr 15}, pages = {910-6}, abstract = {

RATIONALE: Sleep-disordered breathing recurrent intermittent hypoxia and sympathetic nervous system activity surges provide the milieu for cardiac arrhythmia development.

OBJECTIVE: We postulate that the prevalence of nocturnal cardiac arrhythmias is higher among subjects with than without sleep-disordered breathing.

METHODS: The prevalence of arrhythmias was compared in two samples of participants from the Sleep Heart Health Study frequency-matched on age, sex, race/ethnicity, and body mass index: (1) 228 subjects with sleep-disordered breathing (respiratory disturbance index>or=30) and (2) 338 subjects without sleep-disordered breathing (respiratory disturbance index<5).

RESULTS: Atrial fibrillation, nonsustained ventricular tachycardia, and complex ventricular ectopy (nonsustained ventricular tachycardia or bigeminy or trigeminy or quadrigeminy) were more common in subjects with sleep-disordered breathing compared with those without sleep-disordered breathing: 4.8 versus 0.9\% (p=0.003) for atrial fibrillation; 5.3 versus 1.2\% (p=0.004) for nonsustained ventricular tachycardia; 25.0 versus 14.5\% (p=0.002) for complex ventricular ectopy. Compared with those without sleep-disordered breathing and adjusting for age, sex, body mass index, and prevalent coronary heart disease, individuals with sleep-disordered breathing had four times the odds of atrial fibrillation (odds ratio [OR], 4.02; 95\% confidence interval [CI], 1.03-15.74), three times the odds of nonsustained ventricular tachycardia (OR, 3.40; 95\% CI, 1.03-11.20), and almost twice the odds of complex ventricular ectopy (OR, 1.74; 95\% CI, 1.11-2.74). A significant relation was also observed between sleep-disordered breathing and ventricular ectopic beats/h (p<0.0003) considered as a continuous outcome.

CONCLUSIONS: Individuals with severe sleep-disordered breathing have two- to fourfold higher odds of complex arrhythmias than those without sleep-disordered breathing even after adjustment for potential confounders.

}, keywords = {Aged, Aged, 80 and over, Arrhythmias, Cardiac, Circadian Rhythm, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Odds Ratio, Polysomnography, Prevalence, Retrospective Studies, Risk Factors, Severity of Illness Index, Sleep, Sleep Apnea, Obstructive}, issn = {1073-449X}, doi = {10.1164/rccm.200509-1442OC}, author = {Mehra, Reena and Benjamin, Emelia J and Shahar, Eyal and Gottlieb, Daniel J and Nawabit, Rawan and Kirchner, H Lester and Sahadevan, Jayakumar and Redline, Susan} } @article {1016, title = {Sleep-disordered breathing and impaired glucose metabolism in normal-weight and overweight/obese individuals: the Sleep Heart Health Study.}, journal = {Diabetes Care}, volume = {31}, year = {2008}, month = {2008 May}, pages = {1001-6}, abstract = {

OBJECTIVE: To characterize the association between sleep-disordered breathing (SDB) and impaired fasting glucose (IFG), impaired glucose tolerance (IGT), combined IFG and IGT, and occult diabetes in individuals of different body habitus.

RESEARCH DESIGN AND METHODS: Cross-sectional analysis of 2,588 participants (aged 52-96 years; 46\% men) without known diabetes. SDB was defined as respiratory disturbance index >or=10 events/h. IFG, IGT, occult diabetes, and body weight were classified according to recent accepted guidelines. Participants with and without SDB were compared on prevalence and odds ratios for measures of impaired glucose metabolism (IGM), adjusting for age, sex, race, BMI, and waist circumference.

RESULTS: SDB was observed in 209 nonoverweight and 1,036 overweight/obese participants. SDB groups had significantly higher adjusted prevalence and adjusted odds of IFG, IFG plus IGT, and occult diabetes. The adjusted odds ratio for all subjects was 1.3 (95\% CI 1.1-1.6) for IFG, 1.2 (1.0-1.4) for IGT, 1.4 (1.1-2.7) for IFG plus IGT, and 1.7 (1.1-2.7) for occult diabetes.

CONCLUSIONS: SDB was associated with occult diabetes, IFG, and IFG plus IGT, after adjusting for age, sex, race, BMI, and waist circumference. The magnitude of these associations was similar in nonoverweight and overweight participants. The consistency of associations across all measures of IGM and body habitus groups and the significant association between SDB and IFG plus IGT, a risk factor for rapid progression to diabetes, cardiovascular disease, and mortality, suggests the importance of SDB as a risk factor for clinically important levels of metabolic dysfunction.

}, keywords = {Aged, Aged, 80 and over, Body Weight, Cardiovascular Diseases, Cross-Sectional Studies, Female, Glucose Intolerance, Glucose Tolerance Test, Humans, Male, Middle Aged, Obesity, Overweight, Polysomnography, Reference Values, Sleep Wake Disorders}, issn = {1935-5548}, doi = {10.2337/dc07-2003}, author = {Seicean, Sinziana and Kirchner, H Lester and Gottlieb, Daniel J and Punjabi, Naresh M and Resnick, Helaine and Sanders, Mark and Budhiraja, Rohit and Singer, Mendel and Redline, Susan} }