@article {1030, title = {Left ventricular morphology and systolic function in sleep-disordered breathing: the Sleep Heart Health Study.}, journal = {Circulation}, volume = {117}, year = {2008}, month = {2008 May 20}, pages = {2599-607}, abstract = {

BACKGROUND: Whether sleep-disordered breathing (SDB) is a risk factor for left ventricular (LV) hypertrophy and dysfunction is controversial. We assessed the relation of SDB to LV morphology and systolic function in a community-based sample of middle-aged and older adults.

METHODS AND RESULTS: The present study was a cross-sectional observational study of 2058 Sleep Heart Health Study participants (mean age 65+/-12 years; 58\% women; 44\% ethnic minorities) who had technically adequate echocardiograms. A polysomnographically derived apnea-hypopnea index (AHI) and hypoxemia index (percent of sleep time with oxyhemoglobin saturation < 90\%) were used to quantify SDB severity. LV mass index was significantly associated with both AHI and hypoxemia index after adjustment for age, sex, ethnicity, study site, body mass index, current and prior smoking, alcohol consumption, systolic blood pressure, antihypertensive medication use, diabetes mellitus, and prevalent myocardial infarction. Adjusted LV mass index was 41.3 (SD 9.90) g/m(2.7) in participants with AHI < 5 (n=957) and 44.1 (SD 9.90) g/m(2.7) in participants with AHI > or = 30 (n=84) events per hour. Compared with participants with AHI < 5, those with AHI > or = 30 had an adjusted odds ratio of 1.78 (95\% confidence interval 1.14 to 2.79) for LV hypertrophy. A higher AHI and higher hypoxemia index were also associated with larger LV diastolic dimension and lower LV ejection fraction, with a trend toward lower LV fractional shortening. LV wall thickness was significantly associated with the hypoxemia index but not with AHI. Left atrial diameter was not associated with either SDB measure.

CONCLUSIONS: In a community-based cohort, SDB is associated with echocardiographic evidence of increased LV mass and reduced LV systolic function.

}, keywords = {Aged, Echocardiography, Female, Humans, Hypertrophy, Left Ventricular, Hypoxia, Male, Middle Aged, Odds Ratio, Sleep Apnea Syndromes, Systole, Ventricular Dysfunction, Left}, issn = {1524-4539}, doi = {10.1161/CIRCULATIONAHA.107.717892}, author = {Chami, Hassan A and Devereux, Richard B and Gottdiener, John S and Mehra, Reena and Roman, Mary J and Benjamin, Emelia J and Gottlieb, Daniel J} } @article {1137, title = {Brachial artery diameter, blood flow and flow-mediated dilation in sleep-disordered breathing.}, journal = {Vasc Med}, volume = {14}, year = {2009}, month = {2009 Nov}, pages = {351-60}, abstract = {

Clinic-based, case-control studies linked sleep-disordered breathing (SDB) to markers of endothelial dysfunction. We attempted to validate this association in a large community-based sample, and evaluate the relation of SDB to arterial diameter and peripheral blood flow. This community-based, cross-sectional observational study included 327 men and 355 women, aged 42-83 years, from the Framingham Heart Study site of the Sleep Heart Health Study. The polysomnographically derived apnea-hypopnea index and the hypoxemia index (percent sleep time with oxyhemoglobin saturation below 90\%) were used to quantify the severity of SDB. Brachial artery ultrasound measurements included baseline diameter, percent flow-mediated dilation, and baseline and hyperemic flow velocity and volume. The baseline brachial artery diameter was significantly associated with both the apnea-hypopnea index and the hypoxemia index. The association was diminished by adjustment for body mass index, but remained significant for the apnea-hypopnea index. Age-, sex-, race- and body mass index-adjusted mean diameters were 4.32, 4.33, 4.33, 4.56, 4.53 mm for those with apnea-hypopnea index < 1.5, 1.5-4.9, 5-14.9, 15-29.9, >/= 30, respectively; p = 0.03. Baseline flow measures were associated with the apnea-hypopnea index but this association was non-significant after adjusting for body mass index. No significant association was observed between measures of SDB and percent flow-mediated dilation or hyperemic flow in any model. In conclusion, this study supports a moderate association of SDB and larger baseline brachial artery diameter, which may reflect SDB-induced vascular remodeling. This study does not support a link between SDB and endothelial dysfunction as measured by brachial artery flow-mediated dilation.

}, keywords = {Adult, Aged, Aged, 80 and over, Blood Flow Velocity, Brachial Artery, Cross-Sectional Studies, Female, Humans, Hyperemia, Hypoxia, Laser-Doppler Flowmetry, Male, Middle Aged, Polysomnography, Regional Blood Flow, Severity of Illness Index, Sleep Apnea Syndromes, Ultrasonography, Vasodilation}, issn = {1358-863X}, doi = {10.1177/1358863X09105132}, author = {Chami, Hassan A and Keyes, Michelle J and Vita, Joseph A and Mitchell, Gary F and Larson, Martin G and Fan, Shuxia and Vasan, Ramachandran S and O{\textquoteright}Connor, George T and Benjamin, Emelia J and Gottlieb, Daniel J} } @article {1161, title = {Sleepiness, quality of life, and sleep maintenance in REM versus non-REM sleep-disordered breathing.}, journal = {Am J Respir Crit Care Med}, volume = {181}, year = {2010}, month = {2010 May 01}, pages = {997-1002}, abstract = {

RATIONALE: The impact of REM-predominant sleep-disordered breathing (SDB) on sleepiness, quality of life (QOL), and sleep maintenance is uncertain.

OBJECTIVE: To evaluate the association of SDB during REM sleep with daytime sleepiness, health-related QOL, and difficulty maintaining sleep, in comparison to their association with SDB during non-REM sleep in a community-based cohort.

METHODS: Cross-sectional analysis of 5,649 Sleep Heart Health Study participants (mean age 62.5 [SD = 10.9], 52.6\% women, 22.6\% ethnic minorities). SDB during REM and non-REM sleep was quantified using polysomnographically derived apnea-hypopnea index in REM (AHI(REM)) and non-REM (AHI(NREM)) sleep. Sleepiness, sleep maintenance, and QOL were respectively quantified using the Epworth Sleepiness Scale (ESS), the Sleep Heart Health Study Sleep Habit Questionnaire, and the physical and mental composites scales of the Medical Outcomes Study Short Form (SF)-36.

MEASUREMENTS AND MAIN RESULTS: AHI(REM) was not associated with the ESS scores or the physical and mental components scales scores of the SF-36 after adjusting for demographics, body mass index, and AHI(NREM) x AHI(REM) was not associated with frequent difficulty maintaining sleep or early awakening from sleep. AHI(NREM) was associated with the ESS score (beta = 0.25; 95\% confidence interval [CI], 0.16 to 0.34) and the physical (beta = -0.12; 95\% CI, -0.42 to -0.01) and mental (beta = -0.20; 95\% CI, -0.20 to -0.01) components scores of the SF-36 adjusting for demographics, body mass index, and AHI(REM).

CONCLUSIONS: In a community-based sample of middle-aged and older adults, REM-predominant SDB is not independently associated with daytime sleepiness, impaired health-related QOL, or self-reported sleep disruption.

}, keywords = {Aged, Disorders of Excessive Somnolence, Female, Humans, Male, Middle Aged, Polysomnography, Quality of Life, Sleep, Sleep Apnea Syndromes, Sleep, REM}, issn = {1535-4970}, doi = {10.1164/rccm.200908-1304OC}, author = {Chami, Hassan A and Baldwin, Carol M and Silverman, Angela and Zhang, Ying and Rapoport, David and Punjabi, Naresh M and Gottlieb, Daniel J} } @article {1278, title = {Association of incident cardiovascular disease with progression of sleep-disordered breathing.}, journal = {Circulation}, volume = {123}, year = {2011}, month = {2011 Mar 29}, pages = {1280-6}, abstract = {

BACKGROUND: Prospective data suggest that sleep-disordered breathing enhances risk for incident and recurrent cardiovascular disease (CVD). However, a reverse causal pathway whereby incident CVD causes or worsens sleep-disordered breathing has not been studied.

METHODS AND RESULTS: A total of 2721 Sleep Heart Health Study participants (mean age 62, standard deviation=10 years; 57\% women; 23\% minority) without CVD at baseline underwent 2 polysomnograms 5 years apart. Incident CVD events, including myocardial infarction, congestive heart failure, and stroke, were ascertained and adjudicated. The relation of incident CVD to change in apnea-hypopnea index between the 2 polysomnograms was tested with general linear models, with adjustment for age, sex, race, study center, history of diabetes mellitus, change in body mass index, change in neck circumference, percent sleep time spent in supine sleep, and time between the 2 polysomnograms. Incident CVD occurred in 95 participants between the first and second polysomnograms. Compared with participants without incident CVD, those with incident CVD experienced larger increases in apnea-hypopnea index between polysomnograms. The difference in adjusted mean apnea-hypopnea index change between subjects with and without incident CVD was 2.75 events per hour (95\% confidence interval, 0.26 to 5.24; P=0.032). This association persisted after subjects with central sleep apnea were excluded. Compared with participants without incident CVD, participants with incident CVD had greater increases in both mean obstructive and central apnea indices, by 1.75 events per hour (95\% confidence interval, 0.10 to 1.75; P=0.04) and by 1.07 events per hour (95\% confidence interval, 0.40 to 1.74; P=0.001), respectively.

CONCLUSIONS: In a diverse, community-based sample of middle-aged and older adults, incident CVD was associated with worsening sleep-disordered breathing over 5 years.

}, keywords = {Aged, Cardiovascular Diseases, Disease Progression, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Polysomnography, Risk Factors, Sleep Apnea Syndromes}, issn = {1524-4539}, doi = {10.1161/CIRCULATIONAHA.110.974022}, author = {Chami, Hassan A and Resnick, Helaine E and Quan, Stuart F and Gottlieb, Daniel J} }