TY - JOUR T1 - Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. JF - Arch Intern Med Y1 - 2002 A1 - Young, Terry A1 - Shahar, Eyal A1 - Nieto, F Javier A1 - Redline, Susan A1 - Newman, Anne B A1 - Gottlieb, Daniel J A1 - Walsleben, Joyce A A1 - Finn, Laurel A1 - Enright, Paul A1 - Samet, Jonathan M KW - Adult KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Continental Population Groups KW - Female KW - Humans KW - Male KW - Middle Aged KW - Obesity KW - Predictive Value of Tests KW - Residence Characteristics KW - Risk Factors KW - Sex Factors KW - Sleep Apnea Syndromes KW - Snoring AB -

BACKGROUND: Sleep-disordered breathing (SDB) is common, but largely undiagnosed in the general population. Information on demographic patterns of SDB occurrence and its predictive factors in the general population is needed to target high-risk groups that may benefit from diagnosis.

METHODS: The sample comprised 5615 community-dwelling men and women aged between 40 and 98 years who were enrolled in the Sleep Heart Health Study. Data were collected by questionnaire, clinical examinations, and in-home polysomnography. Sleep-disordered breathing status was based on the average number of apnea and hypopnea episodes per hour of sleep (apnea-hypopnea index [AHI]). We used multiple logistic regression modeling to estimate cross-sectional associations of selected participant characteristics with SDB defined by an AHI of 15 or greater.

RESULTS: Male sex, age, body mass index, neck girth, snoring, and repeated breathing pause frequency were independent, significant correlates of an AHI of 15 or greater. People reporting habitual snoring, loud snoring, and frequent breathing pauses were 3 to 4 times more likely to have an AHI of 15 or greater vs an AHI less than 15, but there were weaker associations for other factors with an AHI of 15 or greater. The odds ratios (95% confidence interval) for an AHI of 15 or greater vs an AHI less than 15 were 1.6 and 1.5, respectively, for 1-SD increments in body mass index and neck girth. As age increased, the magnitude of associations for SDB and body habitus, snoring, and breathing pauses decreased.

CONCLUSIONS: A significant proportion of occult SDB in the general population would be missed if screening or case finding were based solely on increased body habitus or male sex. Breathing pauses and obesity may be particularly insensitive for identifying SDB in older people. A better understanding of predictive factors for SDB, particularly in older adults, is needed.

VL - 162 IS - 8 U1 - https://www.ncbi.nlm.nih.gov/pubmed/11966340?dopt=Abstract ER - TY - JOUR T1 - The effects of age, sex, ethnicity, and sleep-disordered breathing on sleep architecture. JF - Arch Intern Med Y1 - 2004 A1 - Redline, Susan A1 - Kirchner, H Lester A1 - Quan, Stuart F A1 - Gottlieb, Daniel J A1 - Kapur, Vishesh A1 - Newman, Anne KW - Adult KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Comorbidity KW - Female KW - Humans KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Sex Factors KW - Sleep KW - Sleep Apnea Syndromes AB -

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.

VL - 164 IS - 4 U1 - https://www.ncbi.nlm.nih.gov/pubmed/14980992?dopt=Abstract ER - TY - JOUR T1 - Polysomnography performed in the unattended home versus the attended laboratory setting--Sleep Heart Health Study methodology. JF - Sleep Y1 - 2004 A1 - Iber, Conrad A1 - Redline, Susan A1 - Kaplan Gilpin, Adele M A1 - Quan, Stuart F A1 - Zhang, Lin A1 - Gottlieb, Daniel J A1 - Rapoport, David A1 - Resnick, Helaine E A1 - Sanders, Mark A1 - Smith, Philip KW - Adult KW - Aged KW - Body Mass Index KW - Clinical Laboratory Techniques KW - Cohort Studies KW - Health Status KW - Home Care Services KW - Humans KW - Middle Aged KW - Polysomnography KW - Sleep Apnea Syndromes KW - Sleep, REM AB -

STUDY OBJECTIVE: To compare polysomnographic recordings obtained in the home and laboratory setting.

DESIGN AND SETTING: Multicenter study comparing unsupervised polysomnography performed in the participant's home with polysomnography supervised at an academic sleep disorders center, using a randomized sequence of study setting. Sleep Heart Health Study (SHHS) standardized polysomnographic recording and scoring techniques were used for both settings.

PARTICIPANTS: 64 of 76 non-SHHS participants recruited from 7 SHHS field sites who had both a laboratory and home polysomnogram meeting acceptable quality criteria.

MEASUREMENTS AND RESULTS: Median sleep duration was greater in the home than in the laboratory (375 vs 318 minutes, respectively, P < .0001) as was sleep efficiency (86% vs 82%, respectively, P < .0024). Very small, but significant increases in percentage of rapid eye movement sleep and decreases in stage 1 sleep were noted in the laboratory. Employing multiple definitions of respiratory disturbance index (RDI), median RDI was similar in both settings (for example, RDI with 3% desaturation: home 12.4, range 0.6-67; laboratory 9.5, range 0.1-93.4, P = .41). Quartile analysis of laboratory RDI showed moderate agreement with home RDI measurements. Based on the mean of laboratory and home RDI and using a cutpoint of 20, there was a biphasic distribution, with the RDI 3% above 20 being more common in the recordings performed in the laboratory than in the home and below 20 being more common in the recordings performed in the home than in the laboratory. These differences could not be attributed to quality of recording, age, sex, or body mass index.

CONCLUSIONS: Using SHHS methodology, median RDI was similar in the unattended home and attended laboratory setting with differences of small magnitude in some sleep parameters. Differences in RDI between settings resulted in a rate of disease misclassification that is similar to repeated studies in the same setting.

VL - 27 IS - 3 U1 - https://www.ncbi.nlm.nih.gov/pubmed/15164911?dopt=Abstract ER - TY - JOUR T1 - Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. JF - Am J Epidemiol Y1 - 2004 A1 - Punjabi, Naresh M A1 - Shahar, Eyal A1 - Redline, Susan A1 - Gottlieb, Daniel J A1 - Givelber, Rachel A1 - Resnick, Helaine E KW - Aged KW - Blood Gas Analysis KW - Body Constitution KW - Body Mass Index KW - Cohort Studies KW - Confounding Factors, Epidemiologic KW - Cross-Sectional Studies KW - Diabetes Mellitus, Type 2 KW - Fasting KW - Female KW - Glucose Intolerance KW - Glucose Tolerance Test KW - Humans KW - Insulin Resistance KW - Linear Models KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Oxyhemoglobins KW - Polysomnography KW - Research Design KW - Risk Factors KW - Severity of Illness Index KW - Sleep Apnea Syndromes AB -

Clinic-based studies suggest that sleep-disordered breathing (SDB) is associated with glucose intolerance and insulin resistance. However, in the available studies, researchers have not rigorously controlled for confounding variables to assess the independent relation between SDB and impaired glucose metabolism. The objective of this study was to determine whether SDB was associated with glucose intolerance and insulin resistance among community-dwelling subjects (n=2,656) participating in the Sleep Heart Health Study (1994-1999). SDB was characterized with the respiratory disturbance index and measurements of oxygen saturation during sleep. Fasting and 2-hour glucose levels measured during an oral glucose tolerance test were used to assess glycemic status. Relative to subjects with a respiratory disturbance index of less than 5.0 events/hour (the reference category), subjects with mild SDB (5.0-14.9 events/hour) and moderate to severe SDB (> or =15 events/hour) had adjusted odds ratios of 1.27 (95% confidence interval: 0.98, 1.64) and 1.46 (95% confidence interval: 1.09, 1.97), respectively, for fasting glucose intolerance (p for trend < 0.01). Sleep-related hypoxemia was also associated with glucose intolerance independently of age, gender, body mass index, and waist circumference. The results of this study suggest that SDB is independently associated with glucose intolerance and insulin resistance and may lead to type 2 diabetes mellitus.

VL - 160 IS - 6 U1 - https://www.ncbi.nlm.nih.gov/pubmed/15353412?dopt=Abstract ER - TY - JOUR T1 - Association of sleep time with diabetes mellitus and impaired glucose tolerance. JF - Arch Intern Med Y1 - 2005 A1 - Gottlieb, Daniel J A1 - Punjabi, Naresh M A1 - Newman, Ann B A1 - Resnick, Helaine E A1 - Redline, Susan A1 - Baldwin, Carol M A1 - Nieto, F Javier KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Blood Glucose KW - Diabetes Mellitus KW - Disease Progression KW - Female KW - Glucose Intolerance KW - Humans KW - Male KW - Middle Aged KW - Odds Ratio KW - Prevalence KW - Prospective Studies KW - Sleep KW - Surveys and Questionnaires KW - Time Factors KW - United States AB -

BACKGROUND: Experimental sleep restriction causes impaired glucose tolerance (IGT); however, little is known about the metabolic effects of habitual sleep restriction. We assessed the cross-sectional relation of usual sleep time to diabetes mellitus (DM) and IGT among participants in the Sleep Heart Health Study, a community-based prospective study of the cardiovascular consequences of sleep-disordered breathing.

METHODS: Participants were 722 men and 764 women, aged 53 to 93 years. Usual sleep time was obtained by standardized questionnaire. Diabetes mellitus was defined as a serum glucose level of 126 mg/dL or more (> or =7.0 mmol/L) fasting or 200 mg/dL or more (> or =11.1 mmol/L) 2 hours following standard oral glucose challenge or medication use for DM. Impaired glucose tolerance was defined as a 2-hour postchallenge glucose level of 140 mg/dL or more (> or =7.8 mmol/L) and less than 200 mg/dL. The relation of sleep time to DM and IGT was examined using categorical logistic regression with adjustment for age, sex, race, body habitus, and apnea-hypopnea index.

RESULTS: The median sleep time was 7 hours per night, with 27.1% of subjects sleeping 6 hours or less per night. Compared with those sleeping 7 to 8 hours per night, subjects sleeping 5 hours or less and 6 hours per night had adjusted odds ratios for DM of 2.51 (95% confidence interval, 1.57-4.02) and 1.66 (95% confidence interval, 1.15-2.39), respectively. Adjusted odds ratios for IGT were 1.33 (95% confidence interval, 0.83-2.15) and 1.58 (95% confidence interval, 1.15-2.18), respectively. Subjects sleeping 9 hours or more per night also had increased odds ratios for DM and IGT. These associations persisted when subjects with insomnia symptoms were excluded.

CONCLUSIONS: A sleep duration of 6 hours or less or 9 hours or more is associated with increased prevalence of DM and IGT. Because this effect was present in subjects without insomnia, voluntary sleep restriction may contribute to the large public health burden of DM.

VL - 165 IS - 8 U1 - https://www.ncbi.nlm.nih.gov/pubmed/15851636?dopt=Abstract ER - TY - JOUR T1 - Sleepiness in patients with moderate to severe sleep-disordered breathing. JF - Sleep Y1 - 2005 A1 - Kapur, Vishesh K A1 - Baldwin, Carol M A1 - Resnick, Helaine E A1 - Gottlieb, Daniel J A1 - Nieto, F Javier KW - Aged KW - Body Mass Index KW - Cohort Studies KW - Cross-Sectional Studies KW - Disorders of Excessive Somnolence KW - Female KW - Humans KW - Male KW - Middle Aged KW - Oxygen KW - Polysomnography KW - Prevalence KW - Risk Factors KW - Severity of Illness Index KW - Sleep Apnea Syndromes KW - Sleep Arousal Disorders KW - Sleep Stages KW - Surveys and Questionnaires AB -

BACKGROUND: Population-based studies suggest that complaints of sleepiness are absent in many individuals with sleep-disordered breathing. We investigated the prevalence of sleepiness as well as factors associated with sleepiness in individuals with moderate to severe sleep-disordered breathing (apnea-hypopnea index > or = 15).

DESIGN: Cross-sectional study.

SETTING: The Sleep Heart Health Study.

PARTICIPANTS: Sleep Heart Health Study participants (N = 6440).

MEASUREMENTS AND RESULTS: Sleepiness was defined as an Epworth Sleepiness Scale score >10 or a report of at least frequently feeling unrested or sleepy. Forty-six percent of participants with moderate to severe sleep-disordered breathing (n = 1149) reported sleepiness. Characteristics associated with sleepiness after adjustment for confounders included presence of respiratory disease, shorter self-reported weekday and weekend sleep, sleep durations, complaints of insufficient sleep, complaints of sleep maintenance insomnia, early morning awakening, habitual snoring, and complaints of awakening with leg cramps or leg jerks. Some respiratory polysomnography measures were associated with sleepiness, but sleep-stage percentages and measures of sleep disruption were not.

CONCLUSIONS: In this community-based cohort, subjective sleepiness is absent in many individuals with significant sleep-disordered breathing. Comorbid conditions, including respiratory disease, sleep restriction, insomnia, and nocturnal leg complaints, are important risk factors for sleepiness in individuals with moderate to severe sleep-disordered breathing.

VL - 28 IS - 4 U1 - https://www.ncbi.nlm.nih.gov/pubmed/16171292?dopt=Abstract ER - TY - JOUR T1 - Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. JF - Am J Respir Crit Care Med Y1 - 2006 A1 - Mehra, Reena A1 - Benjamin, Emelia J A1 - Shahar, Eyal A1 - Gottlieb, Daniel J A1 - Nawabit, Rawan A1 - Kirchner, H Lester A1 - Sahadevan, Jayakumar A1 - Redline, Susan KW - Aged KW - Aged, 80 and over KW - Arrhythmias, Cardiac KW - Circadian Rhythm KW - Electrocardiography KW - Female KW - Follow-Up Studies KW - Humans KW - Male KW - Middle Aged KW - Odds Ratio KW - Polysomnography KW - Prevalence KW - Retrospective Studies KW - Risk Factors KW - Severity of Illness Index KW - Sleep KW - Sleep Apnea, Obstructive AB -

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.

VL - 173 IS - 8 U1 - https://www.ncbi.nlm.nih.gov/pubmed/16424443?dopt=Abstract ER - TY - JOUR T1 - Association of usual sleep duration with hypertension: the Sleep Heart Health Study. JF - Sleep Y1 - 2006 A1 - Gottlieb, Daniel J A1 - Redline, Susan A1 - Nieto, F Javier A1 - Baldwin, Carol M A1 - Newman, Anne B A1 - Resnick, Helaine E A1 - Punjabi, Naresh M KW - Adult KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Cohort Studies KW - Comorbidity KW - Cross-Sectional Studies KW - Female KW - Health Surveys KW - Humans KW - Hypertension KW - Male KW - Middle Aged KW - Odds Ratio KW - Prospective Studies KW - Sleep KW - Sleep Apnea, Obstructive KW - Sleep Deprivation KW - Statistics as Topic AB -

STUDY OBJECTIVES: Limited experimental data suggest that sleep restriction acutely elevates blood pressure; however, little is known about the relationship between usual sleep duration and hypertension. This study assesses the relationship between usual sleep duration and hypertension in a community-based cohort.

DESIGN: Cross-sectional observational study.

SETTING: The Sleep Heart Health Study, a community-based prospective study of the cardiovascular consequences of sleep-disordered breathing.

PARTICIPANTS: Two thousand eight hundred thirteen men and 3097 women, aged 40 to 100 years.

INTERVENTIONS: None.

MEASUREMENTS AND RESULTS: Usual weekday and weekend sleep durations were obtained by questionnaire, and their weighted average were categorized as less than 6, 6 to less than 7, 7 to less than 8, 8 to less than 9, and 9 or more hours per night. Hypertension was defined as a systolic blood pressure of 140 mm Hg or greater, a diastolic blood pressure of 90 mm Hg or greater, or use of medication to treat hypertension. The relationship between sleep duration and hypertension was examined using categorical logistic regression with adjustment for age, sex, race, apnea-hypopnea index, and body mass index. Compared to subjects sleeping 7 to less than 8 hours per night, those sleeping less than 6 and between 6 and 7 hours per night had adjusted odds ratios for hypertension of 1.66 (95% confidence interval 1.35-2.04) and 1.19 (1.02-1.39), respectively, whereas those sleeping between 8 and 9 and 9 or more hours per night had adjusted odds ratios for hypertension of 1.19 (1.04-1.37) and 1.30 (1.04-1.62), respectively (p < .0001 for association of sleep duration with hypertension). These associations persisted when analyses were further adjusted for caffeine and alcohol consumption, current smoking, insomnia symptoms, depression symptoms, sleep efficiency, and prevalent diabetes mellitus or cardiovascular disease.

CONCLUSIONS: Usual sleep duration above or below the median of 7 to less than 8 hours per night is associated with an increased prevalence of hypertension, particularly at the extreme of less than 6 hours per night.

VL - 29 IS - 8 U1 - https://www.ncbi.nlm.nih.gov/pubmed/16944668?dopt=Abstract ER - TY - JOUR T1 - Obstructive sleep apnea and plasma natriuretic peptide levels in a community-based sample. JF - Sleep Y1 - 2006 A1 - Patwardhan, Anjali A A1 - Larson, Martin G A1 - Levy, Daniel A1 - Benjamin, Emelia J A1 - Leip, Eric P A1 - Keyes, Michelle J A1 - Wang, Thomas J A1 - Gottlieb, Daniel J A1 - Vasan, Ramachandran S KW - Atrial Fibrillation KW - Body Mass Index KW - Cohort Studies KW - Female KW - Humans KW - Hypertension KW - Male KW - Middle Aged KW - Myocardial Infarction KW - Natriuretic Peptides KW - Obesity KW - Polysomnography KW - Prevalence KW - Residence Characteristics KW - Severity of Illness Index KW - Sleep Apnea, Obstructive AB -

STUDY OBJECTIVES: We hypothesized that alterations in cardiac hemodynamics associated with obstructive sleep apnea-hypopnea (OSAH) would be reflected in higher natriuretic peptide levels. We examined the association of OSAH with natriuretic peptides in a community-based sample.

DESIGN: Cross-sectional, retrospective, observational study.

SETTING: Framingham Heart Study Offspring Cohort and Sleep Heart Health Study.

PARTICIPANTS: Community-based sample of 623 individuals.

MEASUREMENTS: Full-montage home polysomnography was used to determine apnea-hypopnea index (AHI) and percentage of time with an oxyhemoglobin saturation < 90% (PctLt90). Sensitive immunoradiometric assays were used to measure plasma B-type (BNP) and N-terminal pro-atrial natriuretic peptide (NT-ANP). Multivariable regression was used to examine the relations between natriuretic peptides and indicators of OSAH, adjusting for age, sex, body mass index, and clinical covariates.

RESULTS: No statistically significant relations between OSAH indices and BNP were observed in the multivariable model. Compared with an AHI < 5, relative levels of 1.20, 0.88, and 0.91 were observed forAHI categories 5-15, 15-30, >30 events per hour, respectively. For NT-ANP, no significant relations were seen with AHI in the multivariable model (relative levels of 0.98, 0.91, and 0.90). An inverse association was observed between NT-ANP and PctLt90 in age- and sex-adjusted models (relative levels of 0.93, 0.87, and 0.80), although this association became statistically nonsignificant after adjusting for body mass index.

CONCLUSION: Lack of association of natriuretic peptides with OSAH indices suggests that undiagnosed OSAH may not be associated with major alterations in left ventricular function, as reflected in morning natriuretic peptide levels.

VL - 29 IS - 10 U1 - https://www.ncbi.nlm.nih.gov/pubmed/17068983?dopt=Abstract ER - TY - JOUR T1 - Genome-wide association of sleep and circadian phenotypes. JF - BMC Med Genet Y1 - 2007 A1 - Gottlieb, Daniel J A1 - O'Connor, George T A1 - Wilk, Jemma B KW - Adult KW - Alleles KW - Cardiovascular Diseases KW - Circadian Rhythm KW - Cohort Studies KW - Female KW - Gene Frequency KW - Genetic Linkage KW - Genome, Human KW - Genotype KW - Humans KW - Male KW - Middle Aged KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Sleep KW - Surveys and Questionnaires AB -

BACKGROUND: Numerous studies suggest genetic influences on sleepiness and circadian rhythms. The Sleep Heart Health Study collected questionnaire data on sleep habits and sleepiness from 2848 Framingham Heart Study Offspring Cohort participants. More than 700 participants were genotyped using the Affymetrix 100K SNP GeneChip, providing a unique opportunity to assess genetic linkage and association of these traits.

METHODS: Sleepiness (defined as the Epworth Sleepiness Scale score), usual bedtime and usual sleep duration were assessed by self-completion questionnaire. Standardized residual measures adjusted for age, sex and BMI were analyzed. Multipoint variance components linkage analysis was performed. Association of SNPs to sleep phenotypes was analyzed with both population-based and family-based association tests, with analysis limited to 70,987 autosomal SNPs with minor allele frequency > or =10%, call rate > or =80%, and no significant deviation from Hardy-Weinberg equilibrium (p > or = 0.001).

RESULTS: Heritability of sleepiness was 0.29, bedtime 0.22, and sleep duration 0.17. Both genotype and sleep phenotype data were available for 749 subjects. Linkage analysis revealed five linkage peaks of LOD >2: four to usual bedtime, one to sleep duration. These peaks include several candidate sleep-related genes, including CSNK2A2, encoding a known component of the circadian molecular clock, and PROK2, encoding a putative transmitter of the behavioral circadian rhythm from the suprachiasmatic nucleus. Association tests identified an association of usual bedtime with a non-synonymous coding SNP in NPSR1 that has been shown to encode a gain of function mutation of the neuropeptide S receptor, whose endogenous ligand is a potent promoter of wakefulness. Each copy of the minor allele of this SNP was associated with a 15 minute later mean bedtime. The lowest p value was for association of sleepiness with a SNP located in an intron of PDE4D, which encodes a cAMP-specific phosphodiesterase widely expressed in human brain. Full association results are posted at http://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?id=phs000007 webcite.

CONCLUSION: This analysis confirms prior reports of significant heritability of sleepiness, usual bedtime, and usual sleep duration. Several genetic loci with suggestive linkage to these traits are identified, including linkage peaks containing circadian clock-related genes. Association tests identify NPSR1 and PDE4D as possible mediators of bedtime and sleepiness.

VL - 8 Suppl 1 U1 - https://www.ncbi.nlm.nih.gov/pubmed/17903308?dopt=Abstract ER - TY - JOUR T1 - Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study. JF - Neurology Y1 - 2008 A1 - Winkelman, John W A1 - Shahar, Eyal A1 - Sharief, Imran A1 - Gottlieb, Daniel J KW - Aged KW - Body Mass Index KW - Cardiovascular Diseases KW - Cross-Sectional Studies KW - Evaluation Studies as Topic KW - Female KW - Health Surveys KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Odds Ratio KW - Prevalence KW - Restless Legs Syndrome KW - Surveys and Questionnaires AB -

OBJECTIVE: We evaluated the cross-sectional association between restless legs syndrome (RLS) and prevalent cardiovascular disease (CVD) in a large community-based sample of middle-aged and elderly subjects.

METHODS: This is a cross-sectional observational study of 1,559 men and 1,874 women (mean age of 67.9 years) who were enrolled in the Sleep Heart Health Study, a community-based study of the cardiovascular consequences of sleep-disordered breathing. RLS was defined by positive responses on a self-administered questionnaire to the four diagnostic criteria, with symptoms occurring at least five times per month and associated with at least moderate distress. Coronary artery disease (CAD) was determined by self-report of doctor-diagnosed angina, myocardial infarction, or coronary revascularization procedure. Total CVD included CAD or history of physician-diagnosed stroke or heart failure. The relation of RLS to prevalent CAD and CVD was examined by multivariable logistic regression models

RESULTS: RLS was present in 6.8% of women (n = 128) and 3.3% of men (n = 51). After adjustment for age, sex, race, body mass index, diabetes mellitus, systolic blood pressure, antihypertensive medication use, total:high-density lipoprotein cholesterol ratio, and smoking history, the ORs for CAD were 2.05 (95% CI 1.38 to 3.04) and for CVD were 2.07 (1.43 to 3.00) for subjects with RLS compared to those without RLS. The associations of RLS with CAD and CVD were stronger in those with RLS symptoms at least 16 times per month and were stronger in those with severe than in those with moderately bothersome symptoms.

CONCLUSIONS: Restless legs syndrome (RLS) is associated with prevalent coronary artery disease and cardiovascular disease. This association appears stronger in those with greater frequency or severity of RLS symptoms.

VL - 70 IS - 1 U1 - https://www.ncbi.nlm.nih.gov/pubmed/18166705?dopt=Abstract ER - TY - JOUR T1 - Left ventricular morphology and systolic function in sleep-disordered breathing: the Sleep Heart Health Study. JF - Circulation Y1 - 2008 A1 - Chami, Hassan A A1 - Devereux, Richard B A1 - Gottdiener, John S A1 - Mehra, Reena A1 - Roman, Mary J A1 - Benjamin, Emelia J A1 - Gottlieb, Daniel J KW - Aged KW - Echocardiography KW - Female KW - Humans KW - Hypertrophy, Left Ventricular KW - Hypoxia KW - Male KW - Middle Aged KW - Odds Ratio KW - Sleep Apnea Syndromes KW - Systole KW - Ventricular Dysfunction, Left AB -

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.

VL - 117 IS - 20 U1 - https://www.ncbi.nlm.nih.gov/pubmed/18458174?dopt=Abstract ER - TY - JOUR T1 - Sleep disordered breathing and hypertension: does self-reported sleepiness modify the association? JF - Sleep Y1 - 2008 A1 - Kapur, Vishesh K A1 - Resnick, Helaine E A1 - Gottlieb, Daniel J KW - Aged KW - Antihypertensive Agents KW - Comorbidity KW - Cross-Sectional Studies KW - Disorders of Excessive Somnolence KW - Female KW - Health Surveys KW - Humans KW - Hypertension KW - Male KW - Middle Aged KW - Odds Ratio KW - Oxygen KW - Polysomnography KW - Sleep Apnea, Obstructive KW - United States AB -

STUDY OBJECTIVES: Epidemiologic studies that demonstrate increased risk of hypertension in persons with sleep disordered breathing indicate that only a minority of these persons report significant subjective sleepiness. Studies also suggest that presence of self-reported sleepiness may identify a subset of persons with sleep disordered breathing who are at greatest risk of cardiovascular sequelae, including hypertension. We explore whether self-reported sleepiness modifies the relationship between sleep disordered breathing and prevalent hypertension.

DESIGN: Cross-sectional.

SETTING: Multicenter study.

PARTICIPANTS: 6046 subjects from the Sleep Heart Health Study.

MEASUREMENTS: Polysomnography, systolic and diastolic blood pressure, antihypertensive medication use, questionnaire determined excessive sleepiness and Epworth Sleepiness Scale, and covariates.

RESULTS: The odds of hypertension at higher apnea hypopnea index categories were larger in participants identified as sleepy based on responses to a frequency of sleepiness question or the Epworth score. For example, for those with AHI > or =30 compared to AHI <1.5, the adjusted odds ratio for hypertension was 2.83 (1.33-6.04) among those reporting sleepiness > or =5 days per month, but only 1.22 (0.89-1.68) among those reporting less frequent daytime sleepiness. In adjusted logistic regression models, there was statistical evidence for effect modification by frequency of sleepiness (P = 0.033) of the association between apnea hypopnea index and hypertension. In adjusted models that included the Epworth score as a continuous variable, the interaction term fell slightly short of statistical significance (beta = 0.010, P = 0.07).

CONCLUSION: This study finds that the association of sleep disordered breathing with hypertension is stronger in individuals who report daytime sleepiness than in those who do not.

VL - 31 IS - 8 U1 - https://www.ncbi.nlm.nih.gov/pubmed/18714785?dopt=Abstract ER - TY - JOUR T1 - Sleep-disordered breathing and impaired glucose metabolism in normal-weight and overweight/obese individuals: the Sleep Heart Health Study. JF - Diabetes Care Y1 - 2008 A1 - Seicean, Sinziana A1 - Kirchner, H Lester A1 - Gottlieb, Daniel J A1 - Punjabi, Naresh M A1 - Resnick, Helaine A1 - Sanders, Mark A1 - Budhiraja, Rohit A1 - Singer, Mendel A1 - Redline, Susan KW - Aged KW - Aged, 80 and over KW - Body Weight KW - Cardiovascular Diseases KW - Cross-Sectional Studies KW - Female KW - Glucose Intolerance KW - Glucose Tolerance Test KW - Humans KW - Male KW - Middle Aged KW - Obesity KW - Overweight KW - Polysomnography KW - Reference Values KW - Sleep Wake Disorders AB -

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.

VL - 31 IS - 5 U1 - https://www.ncbi.nlm.nih.gov/pubmed/18268072?dopt=Abstract ER - TY - JOUR T1 - Brachial artery diameter, blood flow and flow-mediated dilation in sleep-disordered breathing. JF - Vasc Med Y1 - 2009 A1 - Chami, Hassan A A1 - Keyes, Michelle J A1 - Vita, Joseph A A1 - Mitchell, Gary F A1 - Larson, Martin G A1 - Fan, Shuxia A1 - Vasan, Ramachandran S A1 - O'Connor, George T A1 - Benjamin, Emelia J A1 - Gottlieb, Daniel J KW - Adult KW - Aged KW - Aged, 80 and over KW - Blood Flow Velocity KW - Brachial Artery KW - Cross-Sectional Studies KW - Female KW - Humans KW - Hyperemia KW - Hypoxia KW - Laser-Doppler Flowmetry KW - Male KW - Middle Aged KW - Polysomnography KW - Regional Blood Flow KW - Severity of Illness Index KW - Sleep Apnea Syndromes KW - Ultrasonography KW - Vasodilation AB -

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.

VL - 14 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19808720?dopt=Abstract ER - TY - JOUR T1 - Polysomnographic and health-related quality of life correlates of restless legs syndrome in the Sleep Heart Health Study. JF - Sleep Y1 - 2009 A1 - Winkelman, John W A1 - Redline, Susan A1 - Baldwin, Carol M A1 - Resnick, Helaine E A1 - Newman, Anne B A1 - Gottlieb, Daniel J KW - Adult KW - Aged KW - Cohort Studies KW - Comorbidity KW - Cross-Sectional Studies KW - Female KW - Humans KW - Male KW - Middle Aged KW - Polysomnography KW - Prospective Studies KW - Quality of Life KW - Restless Legs Syndrome KW - Sleep Initiation and Maintenance Disorders KW - Statistics as Topic AB -

STUDY OBJECTIVES: Sleep disturbance is the primary clinical morbidity of restless legs syndrome (RLS). To date, sleep disturbance in RLS has been measured in (1) clinical samples with polysomnography (PSG) or (2) population-based samples by self-report. The objective of this study was to analyze sleep by PSG in a population-based sample with symptoms of RLS.

DESIGN: Cross-sectional observational study.

SETTING: Community-based.

PARTICIPANTS: 3433 older men and women.

INTERVENTIONS: None.

MEASUREMENTS AND RESULTS: RLS was evaluated using an 8-item self-administered questionnaire based on NIH diagnostic criteria and required symptoms occurring > or = five times per month and associated with at least moderate distress. Health-related quality of life (HRQOL) was determined using the SF-36. Unattended, in-home PSG was performed. Data were assessed using general linear models with adjustment for demographic, health-related variables, and apnea-hypopnea index (AHI). Subjects with RLS had longer adjusted mean sleep latency (39.8 vs 26.4 min, P < 0.0001) and higher arousal index (20.1 vs 18.0, P = 0.0145) than those without RLS. Sleep latency increased progressively as the frequency of RLS symptoms increased from 5-15 days per month to 6-7 days per week. No differences in sleep stage percentages were observed between participants with and without RLS. Subjects with RLS also reported poorer HRQOL in all physical domains as well as in the Mental Health and Vitality domains.

CONCLUSIONS: These novel PSG data from a nonclinical, community-based sample of individuals with RLS document sleep disturbance in the home even in individuals with intermittent symptoms.

VL - 32 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19544754?dopt=Abstract ER - TY - JOUR T1 - Sleep-disordered breathing and mortality: a prospective cohort study. JF - PLoS Med Y1 - 2009 A1 - Punjabi, Naresh M A1 - Caffo, Brian S A1 - Goodwin, James L A1 - Gottlieb, Daniel J A1 - Newman, Anne B A1 - O'Connor, George T A1 - Rapoport, David M A1 - Redline, Susan A1 - Resnick, Helaine E A1 - Robbins, John A A1 - Shahar, Eyal A1 - Unruh, Mark L A1 - Samet, Jonathan M KW - Aged KW - Coronary Artery Disease KW - Female KW - Humans KW - Hypoxia KW - Male KW - Middle Aged KW - Odds Ratio KW - Proportional Hazards Models KW - Prospective Studies KW - Risk Factors KW - Sex Factors KW - Sleep Apnea Syndromes KW - Survival Analysis AB -

BACKGROUND: Sleep-disordered breathing is a common condition associated with adverse health outcomes including hypertension and cardiovascular disease. The overall objective of this study was to determine whether sleep-disordered breathing and its sequelae of intermittent hypoxemia and recurrent arousals are associated with mortality in a community sample of adults aged 40 years or older.

METHODS AND FINDINGS: We prospectively examined whether sleep-disordered breathing was associated with an increased risk of death from any cause in 6,441 men and women participating in the Sleep Heart Health Study. Sleep-disordered breathing was assessed with the apnea-hypopnea index (AHI) based on an in-home polysomnogram. Survival analysis and proportional hazards regression models were used to calculate hazard ratios for mortality after adjusting for age, sex, race, smoking status, body mass index, and prevalent medical conditions. The average follow-up period for the cohort was 8.2 y during which 1,047 participants (587 men and 460 women) died. Compared to those without sleep-disordered breathing (AHI: <5 events/h), the fully adjusted hazard ratios for all-cause mortality in those with mild (AHI: 5.0-14.9 events/h), moderate (AHI: 15.0-29.9 events/h), and severe (AHI: >or=30.0 events/h) sleep-disordered breathing were 0.93 (95% CI: 0.80-1.08), 1.17 (95% CI: 0.97-1.42), and 1.46 (95% CI: 1.14-1.86), respectively. Stratified analyses by sex and age showed that the increased risk of death associated with severe sleep-disordered breathing was statistically significant in men aged 40-70 y (hazard ratio: 2.09; 95% CI: 1.31-3.33). Measures of sleep-related intermittent hypoxemia, but not sleep fragmentation, were independently associated with all-cause mortality. Coronary artery disease-related mortality associated with sleep-disordered breathing showed a pattern of association similar to all-cause mortality.

CONCLUSIONS: Sleep-disordered breathing is associated with all-cause mortality and specifically that due to coronary artery disease, particularly in men aged 40-70 y with severe sleep-disordered breathing. Please see later in the article for the Editors' Summary.

VL - 6 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19688045?dopt=Abstract ER - TY - JOUR T1 - Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. JF - Am J Respir Crit Care Med Y1 - 2010 A1 - Redline, Susan A1 - Yenokyan, Gayane A1 - Gottlieb, Daniel J A1 - Shahar, Eyal A1 - O'Connor, George T A1 - Resnick, Helaine E A1 - Diener-West, Marie A1 - Sanders, Mark H A1 - Wolf, Philip A A1 - Geraghty, Estella M A1 - Ali, Tauqeer A1 - Lebowitz, Michael A1 - Punjabi, Naresh M KW - Aged KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Polysomnography KW - Proportional Hazards Models KW - Prospective Studies KW - Severity of Illness Index KW - Sex Factors KW - Sleep Apnea, Obstructive KW - Stroke AB -

RATIONALE: Although obstructive sleep apnea is associated with physiological perturbations that increase risk of hypertension and are proatherogenic, it is uncertain whether sleep apnea is associated with increased stroke risk in the general population.

OBJECTIVES: To quantify the incidence of ischemic stroke with sleep apnea in a community-based sample of men and women across a wide range of sleep apnea.

METHODS: Baseline polysomnography was performed between 1995 and 1998 in a longitudinal cohort study. The primary exposure was the obstructive apnea-hypopnea index (OAHI) and outcome was incident ischemic stroke.

MEASUREMENTS AND MAIN RESULTS: A total of 5,422 participants without a history of stroke at the baseline examination and untreated for sleep apnea were followed for a median of 8.7 years. One hundred ninety-three ischemic strokes were observed. In covariate-adjusted Cox proportional hazard models, a significant positive association between ischemic stroke and OAHI was observed in men (P value for linear trend: P = 0.016). Men in the highest OAHI quartile (>19) had an adjusted hazard ratio of 2.86 (95% confidence interval, 1.1-7.4). In the mild to moderate range (OAHI, 5-25), each one-unit increase in OAHI in men was estimated to increase stroke risk by 6% (95% confidence interval, 2-10%). In women, stroke was not significantly associated with OAHI quartiles, but increased risk was observed at an OAHI greater than 25.

CONCLUSIONS: The strong adjusted association between ischemic stroke and OAHI in community-dwelling men with mild to moderate sleep apnea suggests that this is an appropriate target for future stroke prevention trials.

VL - 182 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20339144?dopt=Abstract ER - TY - JOUR T1 - Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. JF - Circulation Y1 - 2010 A1 - Gottlieb, Daniel J A1 - Yenokyan, Gayane A1 - Newman, Anne B A1 - O'Connor, George T A1 - Punjabi, Naresh M A1 - Quan, Stuart F A1 - Redline, Susan A1 - Resnick, Helaine E A1 - Tong, Elisa K A1 - Diener-West, Marie A1 - Shahar, Eyal KW - Adult KW - Aged KW - Coronary Disease KW - Female KW - Heart Failure KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Polysomnography KW - Proportional Hazards Models KW - Prospective Studies KW - Sleep Apnea, Obstructive KW - Survival Analysis AB -

BACKGROUND: Clinic-based observational studies in men have reported that obstructive sleep apnea is associated with an increased incidence of coronary heart disease. The objective of this study was to assess the relation of obstructive sleep apnea to incident coronary heart disease and heart failure in a general community sample of adult men and women.

METHODS AND RESULTS: A total of 1927 men and 2495 women > or =40 years of age and free of coronary heart disease and heart failure at the time of baseline polysomnography were followed up for a median of 8.7 years in this prospective longitudinal epidemiological study. After adjustment for multiple risk factors, obstructive sleep apnea was a significant predictor of incident coronary heart disease (myocardial infarction, revascularization procedure, or coronary heart disease death) only in men < or =70 years of age (adjusted hazard ratio 1.10 [95% confidence interval 1.00 to 1.21] per 10-unit increase in apnea-hypopnea index [AHI]) but not in older men or in women of any age. Among men 40 to 70 years old, those with AHI > or =30 were 68% more likely to develop coronary heart disease than those with AHI <5. Obstructive sleep apnea predicted incident heart failure in men but not in women (adjusted hazard ratio 1.13 [95% confidence interval 1.02 to 1.26] per 10-unit increase in AHI). Men with AHI > or =30 were 58% more likely to develop heart failure than those with AHI <5.

CONCLUSIONS: Obstructive sleep apnea is associated with an increased risk of incident heart failure in community-dwelling middle-aged and older men; its association with incident coronary heart disease in this sample is equivocal.

VL - 122 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20625114?dopt=Abstract ER - TY - JOUR T1 - Sleepiness, quality of life, and sleep maintenance in REM versus non-REM sleep-disordered breathing. JF - Am J Respir Crit Care Med Y1 - 2010 A1 - Chami, Hassan A A1 - Baldwin, Carol M A1 - Silverman, Angela A1 - Zhang, Ying A1 - Rapoport, David A1 - Punjabi, Naresh M A1 - Gottlieb, Daniel J KW - Aged KW - Disorders of Excessive Somnolence KW - Female KW - Humans KW - Male KW - Middle Aged KW - Polysomnography KW - Quality of Life KW - Sleep KW - Sleep Apnea Syndromes KW - Sleep, REM AB -

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.

VL - 181 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20093641?dopt=Abstract ER - TY - JOUR T1 - Association of incident cardiovascular disease with progression of sleep-disordered breathing. JF - Circulation Y1 - 2011 A1 - Chami, Hassan A A1 - Resnick, Helaine E A1 - Quan, Stuart F A1 - Gottlieb, Daniel J KW - Aged KW - Cardiovascular Diseases KW - Disease Progression KW - Female KW - Follow-Up Studies KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Polysomnography KW - Risk Factors KW - Sleep Apnea Syndromes AB -

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.

VL - 123 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21403097?dopt=Abstract ER - TY - JOUR T1 - Association of genetic loci with sleep apnea in European Americans and African-Americans: the Candidate Gene Association Resource (CARe). JF - PLoS One Y1 - 2012 A1 - Patel, Sanjay R A1 - Goodloe, Robert A1 - De, Gourab A1 - Kowgier, Matthew A1 - Weng, Jia A1 - Buxbaum, Sarah G A1 - Cade, Brian A1 - Fulop, Tibor A1 - Gharib, Sina A A1 - Gottlieb, Daniel J A1 - Hillman, David A1 - Larkin, Emma K A1 - Lauderdale, Diane S A1 - Li, Li A1 - Mukherjee, Sutapa A1 - Palmer, Lyle A1 - Zee, Phyllis A1 - Zhu, Xiaofeng A1 - Redline, Susan KW - Adult KW - African Americans KW - Aged KW - Alleles KW - European Continental Ancestry Group KW - Female KW - Genetic Association Studies KW - Genetic Loci KW - Genetic Predisposition to Disease KW - Genotype KW - Humans KW - Male KW - Middle Aged KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Polysomnography KW - Sleep Apnea, Obstructive AB -

Although obstructive sleep apnea (OSA) is known to have a strong familial basis, no genetic polymorphisms influencing apnea risk have been identified in cross-cohort analyses. We utilized the National Heart, Lung, and Blood Institute (NHLBI) Candidate Gene Association Resource (CARe) to identify sleep apnea susceptibility loci. Using a panel of 46,449 polymorphisms from roughly 2,100 candidate genes on a customized Illumina iSelect chip, we tested for association with the apnea hypopnea index (AHI) as well as moderate to severe OSA (AHI≥15) in 3,551 participants of the Cleveland Family Study and two cohorts participating in the Sleep Heart Health Study.Among 647 African-Americans, rs11126184 in the pleckstrin (PLEK) gene was associated with OSA while rs7030789 in the lysophosphatidic acid receptor 1 (LPAR1) gene was associated with AHI using a chip-wide significance threshold of p-value<2×10(-6). Among 2,904 individuals of European ancestry, rs1409986 in the prostaglandin E2 receptor (PTGER3) gene was significantly associated with OSA. Consistency of effects between rs7030789 and rs1409986 in LPAR1 and PTGER3 and apnea phenotypes were observed in independent clinic-based cohorts.Novel genetic loci for apnea phenotypes were identified through the use of customized gene chips and meta-analyses of cohort data with replication in clinic-based samples. The identified SNPs all lie in genes associated with inflammation suggesting inflammation may play a role in OSA pathogenesis.

VL - 7 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23155414?dopt=Abstract ER - TY - JOUR T1 - Sleep duration does not mediate or modify association of common genetic variants with type 2 diabetes. JF - Diabetologia Y1 - 2014 A1 - Tare, Archana A1 - Lane, Jacqueline M A1 - Cade, Brian E A1 - Grant, Struan F A A1 - Chen, Ting-Hsu A1 - Punjabi, Naresh M A1 - Lauderdale, Diane S A1 - Zee, Phyllis C A1 - Gharib, Sina A A1 - Gottlieb, Daniel J A1 - Scheer, Frank A J L A1 - Redline, Susan A1 - Saxena, Richa KW - Blood Glucose KW - Body Composition KW - Body Mass Index KW - Cross-Sectional Studies KW - Diabetes Mellitus, Type 2 KW - European Continental Ancestry Group KW - Fasting KW - Female KW - Genetic Predisposition to Disease KW - Genetic Variation KW - Genotype KW - Glucose Intolerance KW - Glycated Hemoglobin A KW - Humans KW - Insulin Resistance KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Risk Factors KW - Sleep KW - Surveys and Questionnaires KW - Time Factors KW - United States AB -

AIMS/HYPOTHESIS: Short and long sleep duration are associated with increased risk of type 2 diabetes. We aimed to investigate whether genetic variants for fasting glucose or type 2 diabetes associate with short or long sleep duration and whether sleep duration modifies the association of genetic variants with these traits.

METHODS: We examined the cross-sectional relationship between self-reported habitual sleep duration and prevalence of type 2 diabetes in individuals of European descent participating in five studies included in the Candidate Gene Association Resource (CARe), totalling 1,474 cases and 8,323 controls. We tested for association of 16 fasting glucose-associated variants, 27 type 2 diabetes-associated variants and aggregate genetic risk scores with continuous and dichotomised (≤5 h or ≥9 h) sleep duration using regression models adjusted for age, sex and BMI. Finally, we tested whether a gene × behaviour interaction of variants with sleep duration had an impact on fasting glucose or type 2 diabetes risk.

RESULTS: Short sleep duration was significantly associated with type 2 diabetes in CARe (OR 1.32; 95% CI 1.08, 1.61; p = 0.008). Variants previously associated with fasting glucose or type 2 diabetes and genetic risk scores were not associated with sleep duration. Furthermore, no study-wide significant interaction was observed between sleep duration and these variants on glycaemic traits. Nominal interactions were observed for sleep duration and PPARG rs1801282, CRY2 rs7943320 and HNF1B rs4430796 in influencing risk of type 2 diabetes (p < 0.05).

CONCLUSIONS/INTERPRETATION: Our findings suggest that differences in habitual sleep duration do not mediate or modify the relationship between common variants underlying glycaemic traits (including in circadian rhythm genes) and diabetes.

VL - 57 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24280871?dopt=Abstract ER - TY - JOUR T1 - Gene-Environment Interactions of Circadian-Related Genes for Cardiometabolic Traits. JF - Diabetes Care Y1 - 2015 A1 - Dashti, Hassan S A1 - Follis, Jack L A1 - Smith, Caren E A1 - Tanaka, Toshiko A1 - Garaulet, Marta A1 - Gottlieb, Daniel J A1 - Hruby, Adela A1 - Jacques, Paul F A1 - Kiefte-de Jong, Jessica C A1 - Lamon-Fava, Stefania A1 - Scheer, Frank A J L A1 - Bartz, Traci M A1 - Kovanen, Leena A1 - Wojczynski, Mary K A1 - Frazier-Wood, Alexis C A1 - Ahluwalia, Tarunveer S A1 - Perälä, Mia-Maria A1 - Jonsson, Anna A1 - Muka, Taulant A1 - Kalafati, Ioanna P A1 - Mikkilä, Vera A1 - Ordovas, Jose M KW - Adult KW - Alleles KW - Blood Glucose KW - Circadian Rhythm Signaling Peptides and Proteins KW - Cohort Studies KW - Diabetes Mellitus, Type 2 KW - Diet, Fat-Restricted KW - European Continental Ancestry Group KW - Fasting KW - Female KW - Gene-Environment Interaction KW - Humans KW - Insulin Resistance KW - Male KW - Middle Aged KW - Multicenter Studies as Topic KW - Observational Studies as Topic KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Sleep KW - Waist Circumference AB -

OBJECTIVE: Common circadian-related gene variants associate with increased risk for metabolic alterations including type 2 diabetes. However, little is known about whether diet and sleep could modify associations between circadian-related variants (CLOCK-rs1801260, CRY2-rs11605924, MTNR1B-rs1387153, MTNR1B-rs10830963, NR1D1-rs2314339) and cardiometabolic traits (fasting glucose [FG], HOMA-insulin resistance, BMI, waist circumference, and HDL-cholesterol) to facilitate personalized recommendations.

RESEARCH DESIGN AND METHODS: We conducted inverse-variance weighted, fixed-effect meta-analyses of results of adjusted associations and interactions between dietary intake/sleep duration and selected variants on cardiometabolic traits from 15 cohort studies including up to 28,190 participants of European descent from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium.

RESULTS: We observed significant associations between relative macronutrient intakes and glycemic traits and short sleep duration (<7 h) and higher FG and replicated known MTNR1B associations with glycemic traits. No interactions were evident after accounting for multiple comparisons. However, we observed nominally significant interactions (all P < 0.01) between carbohydrate intake and MTNR1B-rs1387153 for FG with a 0.003 mmol/L higher FG with each additional 1% carbohydrate intake in the presence of the T allele, between sleep duration and CRY2-rs11605924 for HDL-cholesterol with a 0.010 mmol/L higher HDL-cholesterol with each additional hour of sleep in the presence of the A allele, and between long sleep duration (≥9 h) and MTNR1B-rs1387153 for BMI with a 0.60 kg/m(2) higher BMI with long sleep duration in the presence of the T allele relative to normal sleep duration (≥7 to <9 h).

CONCLUSIONS: Our results suggest that lower carbohydrate intake and normal sleep duration may ameliorate cardiometabolic abnormalities conferred by common circadian-related genetic variants. Until further mechanistic examination of the nominally significant interactions is conducted, recommendations applicable to the general population regarding diet—specifically higher carbohydrate and lower fat composition—and normal sleep duration should continue to be emphasized among individuals with the investigated circadian-related gene variants.

VL - 38 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26084345?dopt=Abstract ER - TY - JOUR T1 - Habitual sleep duration is associated with BMI and macronutrient intake and may be modified by CLOCK genetic variants. JF - Am J Clin Nutr Y1 - 2015 A1 - Dashti, Hassan S A1 - Follis, Jack L A1 - Smith, Caren E A1 - Tanaka, Toshiko A1 - Cade, Brian E A1 - Gottlieb, Daniel J A1 - Hruby, Adela A1 - Jacques, Paul F A1 - Lamon-Fava, Stefania A1 - Richardson, Kris A1 - Saxena, Richa A1 - Scheer, Frank A J L A1 - Kovanen, Leena A1 - Bartz, Traci M A1 - Perälä, Mia-Maria A1 - Jonsson, Anna A1 - Frazier-Wood, Alexis C A1 - Kalafati, Ioanna-Panagiota A1 - Mikkilä, Vera A1 - Partonen, Timo A1 - Lemaitre, Rozenn N A1 - Lahti, Jari A1 - Hernandez, Dena G A1 - Toft, Ulla A1 - Johnson, W Craig A1 - Kanoni, Stavroula A1 - Raitakari, Olli T A1 - Perola, Markus A1 - Psaty, Bruce M A1 - Ferrucci, Luigi A1 - Grarup, Niels A1 - Highland, Heather M A1 - Rallidis, Loukianos A1 - Kähönen, Mika A1 - Havulinna, Aki S A1 - Siscovick, David S A1 - Räikkönen, Katri A1 - Jørgensen, Torben A1 - Rotter, Jerome I A1 - Deloukas, Panos A1 - Viikari, Jorma S A A1 - Mozaffarian, Dariush A1 - Linneberg, Allan A1 - Seppälä, Ilkka A1 - Hansen, Torben A1 - Salomaa, Veikko A1 - Gharib, Sina A A1 - Eriksson, Johan G A1 - Bandinelli, Stefania A1 - Pedersen, Oluf A1 - Rich, Stephen S A1 - Dedoussis, George A1 - Lehtimäki, Terho A1 - Ordovas, Jose M KW - Adult KW - Body Mass Index KW - CLOCK Proteins KW - Cohort Studies KW - Cross-Sectional Studies KW - Diet KW - Dietary Proteins KW - Energy Intake KW - European Continental Ancestry Group KW - Fatty Acids, Unsaturated KW - Female KW - Gene-Environment Interaction KW - Genetic Predisposition to Disease KW - Humans KW - Male KW - Middle Aged KW - Obesity KW - Polymorphism, Single Nucleotide KW - Sleep KW - Young Adult AB -

BACKGROUND: Short sleep duration has been associated with greater risks of obesity, hypertension, diabetes, and cardiovascular disease. Also, common genetic variants in the human Circadian Locomotor Output Cycles Kaput (CLOCK) show associations with ghrelin and total energy intake.

OBJECTIVES: We examined associations between habitual sleep duration, body mass index (BMI), and macronutrient intake and assessed whether CLOCK variants modify these associations.

DESIGN: We conducted inverse-variance weighted, fixed-effect meta-analyses of results of adjusted associations of sleep duration and BMI and macronutrient intake as percentages of total energy as well as interactions with CLOCK variants from 9 cohort studies including up to 14,906 participants of European descent from the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium.

RESULTS: We observed a significant association between sleep duration and lower BMI (β ± SE = 0.16 ± 0.04, P < 0.0001) in the overall sample; however, associations between sleep duration and relative macronutrient intake were evident in age- and sex-stratified analyses only. We observed a significant association between sleep duration and lower saturated fatty acid intake in younger (aged 20-64 y) adults (men: 0.11 ± 0.06%, P = 0.03; women: 0.10 ± 0.05%, P = 0.04) and with lower carbohydrate (-0.31 ± 0.12%, P < 0.01), higher total fat (0.18 ± 0.09%, P = 0.05), and higher PUFA (0.05 ± 0.02%, P = 0.02) intakes in older (aged 65-80 y) women. In addition, the following 2 nominally significant interactions were observed: between sleep duration and rs12649507 on PUFA intake and between sleep duration and rs6858749 on protein intake.

CONCLUSIONS: Our results indicate that longer habitual sleep duration is associated with lower BMI and age- and sex-specific favorable dietary behaviors. Differences in the relative intake of specific macronutrients associated with short sleep duration could, at least in part, explain previously reported associations between short sleep duration and chronic metabolic abnormalities. In addition, the influence of obesity-associated CLOCK variants on the association between sleep duration and macronutrient intake suggests that longer habitual sleep duration could ameliorate the genetic predisposition to obesity via a favorable dietary profile.

VL - 101 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25527757?dopt=Abstract ER - TY - JOUR T1 - Common variants in DRD2 are associated with sleep duration: the CARe consortium. JF - Hum Mol Genet Y1 - 2016 A1 - Cade, Brian E A1 - Gottlieb, Daniel J A1 - Lauderdale, Diane S A1 - Bennett, David A A1 - Buchman, Aron S A1 - Buxbaum, Sarah G A1 - De Jager, Philip L A1 - Evans, Daniel S A1 - Fulop, Tibor A1 - Gharib, Sina A A1 - Johnson, W Craig A1 - Kim, Hyun A1 - Larkin, Emma K A1 - Lee, Seung Ku A1 - Lim, Andrew S A1 - Punjabi, Naresh M A1 - Shin, Chol A1 - Stone, Katie L A1 - Tranah, Gregory J A1 - Weng, Jia A1 - Yaffe, Kristine A1 - Zee, Phyllis C A1 - Patel, Sanjay R A1 - Zhu, Xiaofeng A1 - Redline, Susan A1 - Saxena, Richa KW - Cohort Studies KW - Ethnic Groups KW - Humans KW - Polymorphism, Single Nucleotide KW - Polysomnography KW - Receptors, Dopamine D2 KW - Sleep KW - Time Factors AB -

Sleep duration is implicated in the etiologies of chronic diseases and premature mortality. However, the genetic basis for sleep duration is poorly defined. We sought to identify novel genetic components influencing sleep duration in a multi-ethnic sample. Meta-analyses were conducted of genetic associations with self-reported, habitual sleep duration from seven Candidate Gene Association Resource (CARe) cohorts of over 25 000 individuals of African, Asian, European and Hispanic American ancestry. All individuals were genotyped for ∼50 000 SNPs from 2000 candidate heart, lung, blood and sleep genes. African-Americans had additional genome-wide genotypes. Four cohorts provided replication. A SNP (rs17601612) in the dopamine D2 receptor gene (DRD2) was significantly associated with sleep duration (P = 9.8 × 10(-7)). Conditional analysis identified a second DRD2 signal with opposite effects on sleep duration. In exploratory analysis, suggestive association was observed for rs17601612 with polysomnographically determined sleep latency (P = 0.002). The lead DRD2 signal was recently identified in a schizophrenia GWAS, and a genetic risk score of 11 additional schizophrenia GWAS loci genotyped on the IBC array was also associated with longer sleep duration (P = 0.03). These findings support a role for DRD2 in influencing sleep duration. Our work motivates future pharmocogenetics research on alerting agents such as caffeine and modafinil that interact with the dopaminergic pathway and further investigation of genetic overlap between sleep and neuro-psychiatric traits.

VL - 25 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26464489?dopt=Abstract ER - TY - JOUR T1 - Genetic variants in RBFOX3 are associated with sleep latency. JF - Eur J Hum Genet Y1 - 2016 A1 - Amin, Najaf A1 - Allebrandt, Karla V A1 - van der Spek, Ashley A1 - Müller-Myhsok, Bertram A1 - Hek, Karin A1 - Teder-Laving, Maris A1 - Hayward, Caroline A1 - Esko, Tõnu A1 - van Mill, Josine G A1 - Mbarek, Hamdi A1 - Watson, Nathaniel F A1 - Melville, Scott A A1 - Del Greco, Fabiola M A1 - Byrne, Enda M A1 - Oole, Edwin A1 - Kolcic, Ivana A1 - Chen, Ting-Hsu A1 - Evans, Daniel S A1 - Coresh, Josef A1 - Vogelzangs, Nicole A1 - Karjalainen, Juha A1 - Willemsen, Gonneke A1 - Gharib, Sina A A1 - Zgaga, Lina A1 - Mihailov, Evelin A1 - Stone, Katie L A1 - Campbell, Harry A1 - Brouwer, Rutger Ww A1 - Demirkan, Ayse A1 - Isaacs, Aaron A1 - Dogas, Zoran A1 - Marciante, Kristin D A1 - Campbell, Susan A1 - Borovecki, Fran A1 - Luik, Annemarie I A1 - Li, Man A1 - Hottenga, Jouke Jan A1 - Huffman, Jennifer E A1 - van den Hout, Mirjam Cgn A1 - Cummings, Steven R A1 - Aulchenko, Yurii S A1 - Gehrman, Philip R A1 - Uitterlinden, André G A1 - Wichmann, Heinz-Erich A1 - Müller-Nurasyid, Martina A1 - Fehrmann, Rudolf Sn A1 - Montgomery, Grant W A1 - Hofman, Albert A1 - Kao, Wen Hong Linda A1 - Oostra, Ben A A1 - Wright, Alan F A1 - Vink, Jacqueline M A1 - Wilson, James F A1 - Pramstaller, Peter P A1 - Hicks, Andrew A A1 - Polasek, Ozren A1 - Punjabi, Naresh M A1 - Redline, Susan A1 - Psaty, Bruce M A1 - Heath, Andrew C A1 - Merrow, Martha A1 - Tranah, Gregory J A1 - Gottlieb, Daniel J A1 - Boomsma, Dorret I A1 - Martin, Nicholas G A1 - Rudan, Igor A1 - Tiemeier, Henning A1 - van IJcken, Wilfred Fj A1 - Penninx, Brenda W A1 - Metspalu, Andres A1 - Meitinger, Thomas A1 - Franke, Lude A1 - Roenneberg, Till A1 - van Duijn, Cornelia M AB -

Time to fall asleep (sleep latency) is a major determinant of sleep quality. Chronic, long sleep latency is a major characteristic of sleep-onset insomnia and/or delayed sleep phase syndrome. In this study we aimed to discover common polymorphisms that contribute to the genetics of sleep latency. We performed a meta-analysis of genome-wide association studies (GWAS) including 2 572 737 single nucleotide polymorphisms (SNPs) established in seven European cohorts including 4242 individuals. We found a cluster of three highly correlated variants (rs9900428, rs9907432 and rs7211029) in the RNA-binding protein fox-1 homolog 3 gene (RBFOX3) associated with sleep latency (P-values=5.77 × 10(-08), 6.59 × 10(-)(08) and 9.17 × 10(-)(08)). These SNPs were replicated in up to 12 independent populations including 30 377 individuals (P-values=1.5 × 10(-)(02), 7.0 × 10(-)(03) and 2.5 × 10(-)(03); combined meta-analysis P-values=5.5 × 10(-07), 5.4 × 10(-07) and 1.0 × 10(-07)). A functional prediction of RBFOX3 based on co-expression with other genes shows that this gene is predominantly expressed in brain (P-value=1.4 × 10(-316)) and the central nervous system (P-value=7.5 × 10(-)(321)). The predicted function of RBFOX3 based on co-expression analysis with other genes shows that this gene is significantly involved in the release cycle of neurotransmitters including gamma-aminobutyric acid and various monoamines (P-values<2.9 × 10(-11)) that are crucial in triggering the onset of sleep. To conclude, in this first large-scale GWAS of sleep latency we report a novel association of variants in RBFOX3 gene. Further, a functional prediction of RBFOX3 supports the involvement of RBFOX3 with sleep latency.

VL - 24 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27142678?dopt=Abstract ER - TY - JOUR T1 - Multiethnic Meta-Analysis Identifies RAI1 as a Possible Obstructive Sleep Apnea-related Quantitative Trait Locus in Men. JF - Am J Respir Cell Mol Biol Y1 - 2018 A1 - Chen, Han A1 - Cade, Brian E A1 - Gleason, Kevin J A1 - Bjonnes, Andrew C A1 - Stilp, Adrienne M A1 - Sofer, Tamar A1 - Conomos, Matthew P A1 - Ancoli-Israel, Sonia A1 - Arens, Raanan A1 - Azarbarzin, Ali A1 - Bell, Graeme I A1 - Below, Jennifer E A1 - Chun, Sung A1 - Evans, Daniel S A1 - Ewert, Ralf A1 - Frazier-Wood, Alexis C A1 - Gharib, Sina A A1 - Haba-Rubio, José A1 - Hagen, Erika W A1 - Heinzer, Raphael A1 - Hillman, David R A1 - Johnson, W Craig A1 - Kutalik, Zoltán A1 - Lane, Jacqueline M A1 - Larkin, Emma K A1 - Lee, Seung Ku A1 - Liang, Jingjing A1 - Loredo, Jose S A1 - Mukherjee, Sutapa A1 - Palmer, Lyle J A1 - Papanicolaou, George J A1 - Penzel, Thomas A1 - Peppard, Paul E A1 - Post, Wendy S A1 - Ramos, Alberto R A1 - Rice, Ken A1 - Rotter, Jerome I A1 - Sands, Scott A A1 - Shah, Neomi A A1 - Shin, Chol A1 - Stone, Katie L A1 - Stubbe, Beate A1 - Sul, Jae Hoon A1 - Tafti, Mehdi A1 - Taylor, Kent D A1 - Teumer, Alexander A1 - Thornton, Timothy A A1 - Tranah, Gregory J A1 - Wang, Chaolong A1 - Wang, Heming A1 - Warby, Simon C A1 - Wellman, D Andrew A1 - Zee, Phyllis C A1 - Hanis, Craig L A1 - Laurie, Cathy C A1 - Gottlieb, Daniel J A1 - Patel, Sanjay R A1 - Zhu, Xiaofeng A1 - Sunyaev, Shamil R A1 - Saxena, Richa A1 - Lin, Xihong A1 - Redline, Susan AB -

Obstructive sleep apnea (OSA) is a common heritable disorder displaying marked sexual dimorphism in disease prevalence and progression. Previous genetic association studies have identified a few genetic loci associated with OSA and related quantitative traits, but they have only focused on single ethnic groups, and a large proportion of the heritability remains unexplained. The apnea-hypopnea index (AHI) is a commonly used quantitative measure characterizing OSA severity. Because OSA differs by sex, and the pathophysiology of obstructive events differ in rapid eye movement (REM) and non-REM (NREM) sleep, we hypothesized that additional genetic association signals would be identified by analyzing the NREM/REM-specific AHI and by conducting sex-specific analyses in multiethnic samples. We performed genome-wide association tests for up to 19,733 participants of African, Asian, European, and Hispanic/Latino American ancestry in 7 studies. We identified rs12936587 on chromosome 17 as a possible quantitative trait locus for NREM AHI in men (N = 6,737; P = 1.7 × 10) but not in women (P = 0.77). The association with NREM AHI was replicated in a physiological research study (N = 67; P = 0.047). This locus overlapping the RAI1 gene and encompassing genes PEMT1, SREBF1, and RASD1 was previously reported to be associated with coronary artery disease, lipid metabolism, and implicated in Potocki-Lupski syndrome and Smith-Magenis syndrome, which are characterized by abnormal sleep phenotypes. We also identified gene-by-sex interactions in suggestive association regions, suggesting that genetic variants for AHI appear to vary by sex, consistent with the clinical observations of strong sexual dimorphism.

VL - 58 IS - 3 ER - TY - JOUR T1 - Admixture mapping identifies novel loci for obstructive sleep apnea in Hispanic/Latino Americans. JF - Hum Mol Genet Y1 - 2019 A1 - Wang, Heming A1 - Cade, Brian E A1 - Sofer, Tamar A1 - Sands, Scott A A1 - Chen, Han A1 - Browning, Sharon R A1 - Stilp, Adrienne M A1 - Louie, Tin L A1 - Thornton, Timothy A A1 - Johnson, W Craig A1 - Below, Jennifer E A1 - Conomos, Matthew P A1 - Evans, Daniel S A1 - Gharib, Sina A A1 - Guo, Xiuqing A1 - Wood, Alexis C A1 - Mei, Hao A1 - Yaffe, Kristine A1 - Loredo, Jose S A1 - Ramos, Alberto R A1 - Barrett-Connor, Elizabeth A1 - Ancoli-Israel, Sonia A1 - Zee, Phyllis C A1 - Arens, Raanan A1 - Shah, Neomi A A1 - Taylor, Kent D A1 - Tranah, Gregory J A1 - Stone, Katie L A1 - Hanis, Craig L A1 - Wilson, James G A1 - Gottlieb, Daniel J A1 - Patel, Sanjay R A1 - Rice, Ken A1 - Post, Wendy S A1 - Rotter, Jerome I A1 - Sunyaev, Shamil R A1 - Cai, Jianwen A1 - Lin, Xihong A1 - Purcell, Shaun M A1 - Laurie, Cathy C A1 - Saxena, Richa A1 - Redline, Susan A1 - Zhu, Xiaofeng AB -

Obstructive sleep apnea (OSA) is a common disorder associated with increased risk of cardiovascular disease and mortality. Its prevalence and severity vary across ancestral background. Although OSA traits are heritable, few genetic associations have been identified. To identify genetic regions associated with OSA and improve statistical power, we applied admixture mapping on three primary OSA traits [the apnea hypopnea index (AHI), overnight average oxyhemoglobin saturation (SaO2) and percentage time SaO2 < 90%] and a secondary trait (respiratory event duration) in a Hispanic/Latino American population study of 11 575 individuals with significant variation in ancestral background. Linear mixed models were performed using previously inferred African, European and Amerindian local genetic ancestry markers. Global African ancestry was associated with a lower AHI, higher SaO2 and shorter event duration. Admixture mapping analysis of the primary OSA traits identified local African ancestry at the chromosomal region 2q37 as genome-wide significantly associated with AHI (P < 5.7 × 10-5), and European and Amerindian ancestries at 18q21 suggestively associated with both AHI and percentage time SaO2 < 90% (P < 10-3). Follow-up joint ancestry-SNP association analyses identified novel variants in ferrochelatase (FECH), significantly associated with AHI and percentage time SaO2 < 90% after adjusting for multiple tests (P < 8 × 10-6). These signals contributed to the admixture mapping associations and were replicated in independent cohorts. In this first admixture mapping study of OSA, novel associations with variants in the iron/heme metabolism pathway suggest a role for iron in influencing respiratory traits underlying OSA.

VL - 28 IS - 4 ER - TY - JOUR T1 - Associations of variants In the hexokinase 1 and interleukin 18 receptor regions with oxyhemoglobin saturation during sleep. JF - PLoS Genet Y1 - 2019 A1 - Cade, Brian E A1 - Chen, Han A1 - Stilp, Adrienne M A1 - Louie, Tin A1 - Ancoli-Israel, Sonia A1 - Arens, Raanan A1 - Barfield, Richard A1 - Below, Jennifer E A1 - Cai, Jianwen A1 - Conomos, Matthew P A1 - Evans, Daniel S A1 - Frazier-Wood, Alexis C A1 - Gharib, Sina A A1 - Gleason, Kevin J A1 - Gottlieb, Daniel J A1 - Hillman, David R A1 - Johnson, W Craig A1 - Lederer, David J A1 - Lee, Jiwon A1 - Loredo, Jose S A1 - Mei, Hao A1 - Mukherjee, Sutapa A1 - Patel, Sanjay R A1 - Post, Wendy S A1 - Purcell, Shaun M A1 - Ramos, Alberto R A1 - Reid, Kathryn J A1 - Rice, Ken A1 - Shah, Neomi A A1 - Sofer, Tamar A1 - Taylor, Kent D A1 - Thornton, Timothy A A1 - Wang, Heming A1 - Yaffe, Kristine A1 - Zee, Phyllis C A1 - Hanis, Craig L A1 - Palmer, Lyle J A1 - Rotter, Jerome I A1 - Stone, Katie L A1 - Tranah, Gregory J A1 - Wilson, James G A1 - Sunyaev, Shamil R A1 - Laurie, Cathy C A1 - Zhu, Xiaofeng A1 - Saxena, Richa A1 - Lin, Xihong A1 - Redline, Susan KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Cell Adhesion Molecules, Neuronal KW - Computational Biology KW - Extracellular Matrix Proteins KW - Female KW - Gene Regulatory Networks KW - Genetic Variation KW - Genome-Wide Association Study KW - Hexokinase KW - Humans KW - Hypoxia KW - Interleukin-18 Receptor alpha Subunit KW - Male KW - Middle Aged KW - Nerve Tissue Proteins KW - NLR Family, Pyrin Domain-Containing 3 Protein KW - Oxygen KW - Oxyhemoglobins KW - Polymorphism, Single Nucleotide KW - Quantitative Trait Loci KW - Serine Endopeptidases KW - Sleep KW - Sleep Apnea Syndromes KW - Young Adult AB -

Sleep disordered breathing (SDB)-related overnight hypoxemia is associated with cardiometabolic disease and other comorbidities. Understanding the genetic bases for variations in nocturnal hypoxemia may help understand mechanisms influencing oxygenation and SDB-related mortality. We conducted genome-wide association tests across 10 cohorts and 4 populations to identify genetic variants associated with three correlated measures of overnight oxyhemoglobin saturation: average and minimum oxyhemoglobin saturation during sleep and the percent of sleep with oxyhemoglobin saturation under 90%. The discovery sample consisted of 8,326 individuals. Variants with p < 1 × 10(-6) were analyzed in a replication group of 14,410 individuals. We identified 3 significantly associated regions, including 2 regions in multi-ethnic analyses (2q12, 10q22). SNPs in the 2q12 region associated with minimum SpO2 (rs78136548 p = 2.70 × 10(-10)). SNPs at 10q22 were associated with all three traits including average SpO2 (rs72805692 p = 4.58 × 10(-8)). SNPs in both regions were associated in over 20,000 individuals and are supported by prior associations or functional evidence. Four additional significant regions were detected in secondary sex-stratified and combined discovery and replication analyses, including a region overlapping Reelin, a known marker of respiratory complex neurons.These are the first genome-wide significant findings reported for oxyhemoglobin saturation during sleep, a phenotype of high clinical interest. Our replicated associations with HK1 and IL18R1 suggest that variants in inflammatory pathways, such as the biologically-plausible NLRP3 inflammasome, may contribute to nocturnal hypoxemia.

VL - 15 IS - 4 ER - TY - JOUR T1 - Multi-ancestry sleep-by-SNP interaction analysis in 126,926 individuals reveals lipid loci stratified by sleep duration. JF - Nat Commun Y1 - 2019 A1 - Noordam, Raymond A1 - Bos, Maxime M A1 - Wang, Heming A1 - Winkler, Thomas W A1 - Bentley, Amy R A1 - Kilpeläinen, Tuomas O A1 - de Vries, Paul S A1 - Sung, Yun Ju A1 - Schwander, Karen A1 - Cade, Brian E A1 - Manning, Alisa A1 - Aschard, Hugues A1 - Brown, Michael R A1 - Chen, Han A1 - Franceschini, Nora A1 - Musani, Solomon K A1 - Richard, Melissa A1 - Vojinovic, Dina A1 - Aslibekyan, Stella A1 - Bartz, Traci M A1 - de Las Fuentes, Lisa A1 - Feitosa, Mary A1 - Horimoto, Andrea R A1 - Ilkov, Marjan A1 - Kho, Minjung A1 - Kraja, Aldi A1 - Li, Changwei A1 - Lim, Elise A1 - Liu, Yongmei A1 - Mook-Kanamori, Dennis O A1 - Rankinen, Tuomo A1 - Tajuddin, Salman M A1 - van der Spek, Ashley A1 - Wang, Zhe A1 - Marten, Jonathan A1 - Laville, Vincent A1 - Alver, Maris A1 - Evangelou, Evangelos A1 - Graff, Maria E A1 - He, Meian A1 - Kuhnel, Brigitte A1 - Lyytikäinen, Leo-Pekka A1 - Marques-Vidal, Pedro A1 - Nolte, Ilja M A1 - Palmer, Nicholette D A1 - Rauramaa, Rainer A1 - Shu, Xiao-Ou A1 - Snieder, Harold A1 - Weiss, Stefan A1 - Wen, Wanqing A1 - Yanek, Lisa R A1 - Adolfo, Correa A1 - Ballantyne, Christie A1 - Bielak, Larry A1 - Biermasz, Nienke R A1 - Boerwinkle, Eric A1 - Dimou, Niki A1 - Eiriksdottir, Gudny A1 - Gao, Chuan A1 - Gharib, Sina A A1 - Gottlieb, Daniel J A1 - Haba-Rubio, José A1 - Harris, Tamara B A1 - Heikkinen, Sami A1 - Heinzer, Raphael A1 - Hixson, James E A1 - Homuth, Georg A1 - Ikram, M Arfan A1 - Komulainen, Pirjo A1 - Krieger, Jose E A1 - Lee, Jiwon A1 - Liu, Jingmin A1 - Lohman, Kurt K A1 - Luik, Annemarie I A1 - Mägi, Reedik A1 - Martin, Lisa W A1 - Meitinger, Thomas A1 - Metspalu, Andres A1 - Milaneschi, Yuri A1 - Nalls, Mike A A1 - O'Connell, Jeff A1 - Peters, Annette A1 - Peyser, Patricia A1 - Raitakari, Olli T A1 - Reiner, Alex P A1 - Rensen, Patrick C N A1 - Rice, Treva K A1 - Rich, Stephen S A1 - Roenneberg, Till A1 - Rotter, Jerome I A1 - Schreiner, Pamela J A1 - Shikany, James A1 - Sidney, Stephen S A1 - Sims, Mario A1 - Sitlani, Colleen M A1 - Sofer, Tamar A1 - Strauch, Konstantin A1 - Swertz, Morris A A1 - Taylor, Kent D A1 - Uitterlinden, André G A1 - van Duijn, Cornelia M A1 - Völzke, Henry A1 - Waldenberger, Melanie A1 - Wallance, Robert B A1 - van Dijk, Ko Willems A1 - Yu, Caizheng A1 - Zonderman, Alan B A1 - Becker, Diane M A1 - Elliott, Paul A1 - Esko, Tõnu A1 - Gieger, Christian A1 - Grabe, Hans J A1 - Lakka, Timo A A1 - Lehtimäki, Terho A1 - North, Kari E A1 - Penninx, Brenda W J H A1 - Vollenweider, Peter A1 - Wagenknecht, Lynne E A1 - Wu, Tangchun A1 - Xiang, Yong-Bing A1 - Zheng, Wei A1 - Arnett, Donna K A1 - Bouchard, Claude A1 - Evans, Michele K A1 - Gudnason, Vilmundur A1 - Kardia, Sharon A1 - Kelly, Tanika N A1 - Kritchevsky, Stephen B A1 - Loos, Ruth J F A1 - Pereira, Alexandre C A1 - Province, Mike A1 - Psaty, Bruce M A1 - Rotimi, Charles A1 - Zhu, Xiaofeng A1 - Amin, Najaf A1 - Cupples, L Adrienne A1 - Fornage, Myriam A1 - Fox, Ervin F A1 - Guo, Xiuqing A1 - Gauderman, W James A1 - Rice, Kenneth A1 - Kooperberg, Charles A1 - Munroe, Patricia B A1 - Liu, Ching-Ti A1 - Morrison, Alanna C A1 - Rao, Dabeeru C A1 - van Heemst, Diana A1 - Redline, Susan AB -

Both short and long sleep are associated with an adverse lipid profile, likely through different biological pathways. To elucidate the biology of sleep-associated adverse lipid profile, we conduct multi-ancestry genome-wide sleep-SNP interaction analyses on three lipid traits (HDL-c, LDL-c and triglycerides). In the total study sample (discovery + replication) of 126,926 individuals from 5 different ancestry groups, when considering either long or short total sleep time interactions in joint analyses, we identify 49 previously unreported lipid loci, and 10 additional previously unreported lipid loci in a restricted sample of European-ancestry cohorts. In addition, we identify new gene-sleep interactions for known lipid loci such as LPL and PCSK9. The previously unreported lipid loci have a modest explained variance in lipid levels: most notable, gene-short-sleep interactions explain 4.25% of the variance in triglyceride level. Collectively, these findings contribute to our understanding of the biological mechanisms involved in sleep-associated adverse lipid profiles.

VL - 10 IS - 1 ER - TY - JOUR T1 - Sequencing Analysis at 8p23 Identifies Multiple Rare Variants in DLC1 Associated with Sleep-Related Oxyhemoglobin Saturation Level. JF - Am J Hum Genet Y1 - 2019 A1 - Liang, Jingjing A1 - Cade, Brian E A1 - He, Karen Y A1 - Wang, Heming A1 - Lee, Jiwon A1 - Sofer, Tamar A1 - Williams, Stephanie A1 - Li, Ruitong A1 - Chen, Han A1 - Gottlieb, Daniel J A1 - Evans, Daniel S A1 - Guo, Xiuqing A1 - Gharib, Sina A A1 - Hale, Lauren A1 - Hillman, David R A1 - Lutsey, Pamela L A1 - Mukherjee, Sutapa A1 - Ochs-Balcom, Heather M A1 - Palmer, Lyle J A1 - Rhodes, Jessica A1 - Purcell, Shaun A1 - Patel, Sanjay R A1 - Saxena, Richa A1 - Stone, Katie L A1 - Tang, Weihong A1 - Tranah, Gregory J A1 - Boerwinkle, Eric A1 - Lin, Xihong A1 - Liu, Yongmei A1 - Psaty, Bruce M A1 - Vasan, Ramachandran S A1 - Cho, Michael H A1 - Manichaikul, Ani A1 - Silverman, Edwin K A1 - Barr, R Graham A1 - Rich, Stephen S A1 - Rotter, Jerome I A1 - Wilson, James G A1 - Redline, Susan A1 - Zhu, Xiaofeng AB -

Average arterial oxyhemoglobin saturation during sleep (AvSpOS) is a clinically relevant measure of physiological stress associated with sleep-disordered breathing, and this measure predicts incident cardiovascular disease and mortality. Using high-depth whole-genome sequencing data from the National Heart, Lung, and Blood Institute (NHLBI) Trans-Omics for Precision Medicine (TOPMed) project and focusing on genes with linkage evidence on chromosome 8p23, we observed that six coding and 51 noncoding variants in a gene that encodes the GTPase-activating protein (DLC1) are significantly associated with AvSpOS and replicated in independent subjects. The combined DLC1 association evidence of discovery and replication cohorts reaches genome-wide significance in European Americans (p = 7.9 × 10). A risk score for these variants, built on an independent dataset, explains 0.97% of the AvSpOS variation and contributes to the linkage evidence. The 51 noncoding variants are enriched in regulatory features in a human lung fibroblast cell line and contribute to DLC1 expression variation. Mendelian randomization analysis using these variants indicates a significant causal effect of DLC1 expression in fibroblasts on AvSpOS. Multiple sources of information, including genetic variants, gene expression, and methylation, consistently suggest that DLC1 is a gene associated with AvSpOS.

VL - 105 IS - 5 ER - TY - JOUR T1 - BinomiRare: A robust test for association of a rare genetic variant with a binary outcome for mixed models and any case-control proportion. JF - HGG Adv Y1 - 2021 A1 - Sofer, Tamar A1 - Lee, Jiwon A1 - Kurniansyah, Nuzulul A1 - Jain, Deepti A1 - Laurie, Cecelia A A1 - Gogarten, Stephanie M A1 - Conomos, Matthew P A1 - Heavner, Ben A1 - Hu, Yao A1 - Kooperberg, Charles A1 - Haessler, Jeffrey A1 - Vasan, Ramachandran S A1 - Cupples, L Adrienne A1 - Coombes, Brandon J A1 - Seyerle, Amanda A1 - Gharib, Sina A A1 - Chen, Han A1 - O'Connell, Jeffrey R A1 - Zhang, Man A1 - Gottlieb, Daniel J A1 - Psaty, Bruce M A1 - Longstreth, W T A1 - Rotter, Jerome I A1 - Taylor, Kent D A1 - Rich, Stephen S A1 - Guo, Xiuqing A1 - Boerwinkle, Eric A1 - Morrison, Alanna C A1 - Pankow, James S A1 - Johnson, Andrew D A1 - Pankratz, Nathan A1 - Reiner, Alex P A1 - Redline, Susan A1 - Smith, Nicholas L A1 - Rice, Kenneth M A1 - Schifano, Elizabeth D AB -

Whole-genome sequencing (WGS) and whole-exome sequencing studies have become increasingly available and are being used to identify rare genetic variants associated with health and disease outcomes. Investigators routinely use mixed models to account for genetic relatedness or other clustering variables (e.g., family or household) when testing genetic associations. However, no existing tests of the association of a rare variant with a binary outcome in the presence of correlated data control the type 1 error where there are (1) few individuals harboring the rare allele, (2) a small proportion of cases relative to controls, and (3) covariates to adjust for. Here, we address all three issues in developing a framework for testing rare variant association with a binary trait in individuals harboring at least one risk allele. In this framework, we estimate outcome probabilities under the null hypothesis and then use them, within the individuals with at least one risk allele, to test variant associations. We extend the BinomiRare test, which was previously proposed for independent observations, and develop the Conway-Maxwell-Poisson (CMP) test and study their properties in simulations. We show that the BinomiRare test always controls the type 1 error, while the CMP test sometimes does not. We then use the BinomiRare test to test the association of rare genetic variants in target genes with small-vessel disease (SVD) stroke, short sleep, and venous thromboembolism (VTE), in whole-genome sequence data from the Trans-Omics for Precision Medicine (TOPMed) program.

VL - 2 IS - 3 ER - TY - JOUR T1 - Multi-ancestry genome-wide gene-sleep interactions identify novel loci for blood pressure. JF - Mol Psychiatry Y1 - 2021 A1 - Wang, Heming A1 - Noordam, Raymond A1 - Cade, Brian E A1 - Schwander, Karen A1 - Winkler, Thomas W A1 - Lee, Jiwon A1 - Sung, Yun Ju A1 - Bentley, Amy R A1 - Manning, Alisa K A1 - Aschard, Hugues A1 - Kilpeläinen, Tuomas O A1 - Ilkov, Marjan A1 - Brown, Michael R A1 - Horimoto, Andrea R A1 - Richard, Melissa A1 - Bartz, Traci M A1 - Vojinovic, Dina A1 - Lim, Elise A1 - Nierenberg, Jovia L A1 - Liu, Yongmei A1 - Chitrala, Kumaraswamynaidu A1 - Rankinen, Tuomo A1 - Musani, Solomon K A1 - Franceschini, Nora A1 - Rauramaa, Rainer A1 - Alver, Maris A1 - Zee, Phyllis C A1 - Harris, Sarah E A1 - van der Most, Peter J A1 - Nolte, Ilja M A1 - Munroe, Patricia B A1 - Palmer, Nicholette D A1 - Kuhnel, Brigitte A1 - Weiss, Stefan A1 - Wen, Wanqing A1 - Hall, Kelly A A1 - Lyytikäinen, Leo-Pekka A1 - O'Connell, Jeff A1 - Eiriksdottir, Gudny A1 - Launer, Lenore J A1 - de Vries, Paul S A1 - Arking, Dan E A1 - Chen, Han A1 - Boerwinkle, Eric A1 - Krieger, Jose E A1 - Schreiner, Pamela J A1 - Sidney, Stephen A1 - Shikany, James M A1 - Rice, Kenneth A1 - Chen, Yii-Der Ida A1 - Gharib, Sina A A1 - Bis, Joshua C A1 - Luik, Annemarie I A1 - Ikram, M Arfan A1 - Uitterlinden, André G A1 - Amin, Najaf A1 - Xu, Hanfei A1 - Levy, Daniel A1 - He, Jiang A1 - Lohman, Kurt K A1 - Zonderman, Alan B A1 - Rice, Treva K A1 - Sims, Mario A1 - Wilson, Gregory A1 - Sofer, Tamar A1 - Rich, Stephen S A1 - Palmas, Walter A1 - Yao, Jie A1 - Guo, Xiuqing A1 - Rotter, Jerome I A1 - Biermasz, Nienke R A1 - Mook-Kanamori, Dennis O A1 - Martin, Lisa W A1 - Barac, Ana A1 - Wallace, Robert B A1 - Gottlieb, Daniel J A1 - Komulainen, Pirjo A1 - Heikkinen, Sami A1 - Mägi, Reedik A1 - Milani, Lili A1 - Metspalu, Andres A1 - Starr, John M A1 - Milaneschi, Yuri A1 - Waken, R J A1 - Gao, Chuan A1 - Waldenberger, Melanie A1 - Peters, Annette A1 - Strauch, Konstantin A1 - Meitinger, Thomas A1 - Roenneberg, Till A1 - Völker, Uwe A1 - Dörr, Marcus A1 - Shu, Xiao-Ou A1 - Mukherjee, Sutapa A1 - Hillman, David R A1 - Kähönen, Mika A1 - Wagenknecht, Lynne E A1 - Gieger, Christian A1 - Grabe, Hans J A1 - Zheng, Wei A1 - Palmer, Lyle J A1 - Lehtimäki, Terho A1 - Gudnason, Vilmundur A1 - Morrison, Alanna C A1 - Pereira, Alexandre C A1 - Fornage, Myriam A1 - Psaty, Bruce M A1 - van Duijn, Cornelia M A1 - Liu, Ching-Ti A1 - Kelly, Tanika N A1 - Evans, Michele K A1 - Bouchard, Claude A1 - Fox, Ervin R A1 - Kooperberg, Charles A1 - Zhu, Xiaofeng A1 - Lakka, Timo A A1 - Esko, Tõnu A1 - North, Kari E A1 - Deary, Ian J A1 - Snieder, Harold A1 - Penninx, Brenda W J H A1 - Gauderman, W James A1 - Rao, Dabeeru C A1 - Redline, Susan A1 - van Heemst, Diana AB -

Long and short sleep duration are associated with elevated blood pressure (BP), possibly through effects on molecular pathways that influence neuroendocrine and vascular systems. To gain new insights into the genetic basis of sleep-related BP variation, we performed genome-wide gene by short or long sleep duration interaction analyses on four BP traits (systolic BP, diastolic BP, mean arterial pressure, and pulse pressure) across five ancestry groups in two stages using 2 degree of freedom (df) joint test followed by 1df test of interaction effects. Primary multi-ancestry analysis in 62,969 individuals in stage 1 identified three novel gene by sleep interactions that were replicated in an additional 59,296 individuals in stage 2 (stage 1 + 2 P < 5 × 10), including rs7955964 (FIGNL2/ANKRD33) that increases BP among long sleepers, and rs73493041 (SNORA26/C9orf170) and rs10406644 (KCTD15/LSM14A) that increase BP among short sleepers (P < 5 × 10). Secondary ancestry-specific analysis identified another novel gene by long sleep interaction at rs111887471 (TRPC3/KIAA1109) in individuals of African ancestry (P = 2 × 10). Combined stage 1 and 2 analyses additionally identified significant gene by long sleep interactions at 10 loci including MKLN1 and RGL3/ELAVL3 previously associated with BP, and significant gene by short sleep interactions at 10 loci including C2orf43 previously associated with BP (P < 10). 2df test also identified novel loci for BP after modeling sleep that has known functions in sleep-wake regulation, nervous and cardiometabolic systems. This study indicates that sleep and primary mechanisms regulating BP may interact to elevate BP level, suggesting novel insights into sleep-related BP regulation.

ER - TY - JOUR T1 - Sequencing of 53,831 diverse genomes from the NHLBI TOPMed Program. JF - Nature Y1 - 2021 A1 - Taliun, Daniel A1 - Harris, Daniel N A1 - Kessler, Michael D A1 - Carlson, Jedidiah A1 - Szpiech, Zachary A A1 - Torres, Raul A1 - Taliun, Sarah A Gagliano A1 - Corvelo, André A1 - Gogarten, Stephanie M A1 - Kang, Hyun Min A1 - Pitsillides, Achilleas N A1 - LeFaive, Jonathon A1 - Lee, Seung-Been A1 - Tian, Xiaowen A1 - Browning, Brian L A1 - Das, Sayantan A1 - Emde, Anne-Katrin A1 - Clarke, Wayne E A1 - Loesch, Douglas P A1 - Shetty, Amol C A1 - Blackwell, Thomas W A1 - Smith, Albert V A1 - Wong, Quenna A1 - Liu, Xiaoming A1 - Conomos, Matthew P A1 - Bobo, Dean M A1 - Aguet, Francois A1 - Albert, Christine A1 - Alonso, Alvaro A1 - Ardlie, Kristin G A1 - Arking, Dan E A1 - Aslibekyan, Stella A1 - Auer, Paul L A1 - Barnard, John A1 - Barr, R Graham A1 - Barwick, Lucas A1 - Becker, Lewis C A1 - Beer, Rebecca L A1 - Benjamin, Emelia J A1 - Bielak, Lawrence F A1 - Blangero, John A1 - Boehnke, Michael A1 - Bowden, Donald W A1 - Brody, Jennifer A A1 - Burchard, Esteban G A1 - Cade, Brian E A1 - Casella, James F A1 - Chalazan, Brandon A1 - Chasman, Daniel I A1 - Chen, Yii-Der Ida A1 - Cho, Michael H A1 - Choi, Seung Hoan A1 - Chung, Mina K A1 - Clish, Clary B A1 - Correa, Adolfo A1 - Curran, Joanne E A1 - Custer, Brian A1 - Darbar, Dawood A1 - Daya, Michelle A1 - de Andrade, Mariza A1 - DeMeo, Dawn L A1 - Dutcher, Susan K A1 - Ellinor, Patrick T A1 - Emery, Leslie S A1 - Eng, Celeste A1 - Fatkin, Diane A1 - Fingerlin, Tasha A1 - Forer, Lukas A1 - Fornage, Myriam A1 - Franceschini, Nora A1 - Fuchsberger, Christian A1 - Fullerton, Stephanie M A1 - Germer, Soren A1 - Gladwin, Mark T A1 - Gottlieb, Daniel J A1 - Guo, Xiuqing A1 - Hall, Michael E A1 - He, Jiang A1 - Heard-Costa, Nancy L A1 - Heckbert, Susan R A1 - Irvin, Marguerite R A1 - Johnsen, Jill M A1 - Johnson, Andrew D A1 - Kaplan, Robert A1 - Kardia, Sharon L R A1 - Kelly, Tanika A1 - Kelly, Shannon A1 - Kenny, Eimear E A1 - Kiel, Douglas P A1 - Klemmer, Robert A1 - Konkle, Barbara A A1 - Kooperberg, Charles A1 - Köttgen, Anna A1 - Lange, Leslie A A1 - Lasky-Su, Jessica A1 - Levy, Daniel A1 - Lin, Xihong A1 - Lin, Keng-Han A1 - Liu, Chunyu A1 - Loos, Ruth J F A1 - Garman, Lori A1 - Gerszten, Robert A1 - Lubitz, Steven A A1 - Lunetta, Kathryn L A1 - Mak, Angel C Y A1 - Manichaikul, Ani A1 - Manning, Alisa K A1 - Mathias, Rasika A A1 - McManus, David D A1 - McGarvey, Stephen T A1 - Meigs, James B A1 - Meyers, Deborah A A1 - Mikulla, Julie L A1 - Minear, Mollie A A1 - Mitchell, Braxton D A1 - Mohanty, Sanghamitra A1 - Montasser, May E A1 - Montgomery, Courtney A1 - Morrison, Alanna C A1 - Murabito, Joanne M A1 - Natale, Andrea A1 - Natarajan, Pradeep A1 - Nelson, Sarah C A1 - North, Kari E A1 - O'Connell, Jeffrey R A1 - Palmer, Nicholette D A1 - Pankratz, Nathan A1 - Peloso, Gina M A1 - Peyser, Patricia A A1 - Pleiness, Jacob A1 - Post, Wendy S A1 - Psaty, Bruce M A1 - Rao, D C A1 - Redline, Susan A1 - Reiner, Alexander P A1 - Roden, Dan A1 - Rotter, Jerome I A1 - Ruczinski, Ingo A1 - Sarnowski, Chloe A1 - Schoenherr, Sebastian A1 - Schwartz, David A A1 - Seo, Jeong-Sun A1 - Seshadri, Sudha A1 - Sheehan, Vivien A A1 - Sheu, Wayne H A1 - Shoemaker, M Benjamin A1 - Smith, Nicholas L A1 - Smith, Jennifer A A1 - Sotoodehnia, Nona A1 - Stilp, Adrienne M A1 - Tang, Weihong A1 - Taylor, Kent D A1 - Telen, Marilyn A1 - Thornton, Timothy A A1 - Tracy, Russell P A1 - Van Den Berg, David J A1 - Vasan, Ramachandran S A1 - Viaud-Martinez, Karine A A1 - Vrieze, Scott A1 - Weeks, Daniel E A1 - Weir, Bruce S A1 - Weiss, Scott T A1 - Weng, Lu-Chen A1 - Willer, Cristen J A1 - Zhang, Yingze A1 - Zhao, Xutong A1 - Arnett, Donna K A1 - Ashley-Koch, Allison E A1 - Barnes, Kathleen C A1 - Boerwinkle, Eric A1 - Gabriel, Stacey A1 - Gibbs, Richard A1 - Rice, Kenneth M A1 - Rich, Stephen S A1 - Silverman, Edwin K A1 - Qasba, Pankaj A1 - Gan, Weiniu A1 - Papanicolaou, George J A1 - Nickerson, Deborah A A1 - Browning, Sharon R A1 - Zody, Michael C A1 - Zöllner, Sebastian A1 - Wilson, James G A1 - Cupples, L Adrienne A1 - Laurie, Cathy C A1 - Jaquish, Cashell E A1 - Hernandez, Ryan D A1 - O'Connor, Timothy D A1 - Abecasis, Goncalo R AB -

The Trans-Omics for Precision Medicine (TOPMed) programme seeks to elucidate the genetic architecture and biology of heart, lung, blood and sleep disorders, with the ultimate goal of improving diagnosis, treatment and prevention of these diseases. The initial phases of the programme focused on whole-genome sequencing of individuals with rich phenotypic data and diverse backgrounds. Here we describe the TOPMed goals and design as well as the available resources and early insights obtained from the sequence data. The resources include a variant browser, a genotype imputation server, and genomic and phenotypic data that are available through dbGaP (Database of Genotypes and Phenotypes). In the first 53,831 TOPMed samples, we detected more than 400 million single-nucleotide and insertion or deletion variants after alignment with the reference genome. Additional previously undescribed variants were detected through assembly of unmapped reads and customized analysis in highly variable loci. Among the more than 400 million detected variants, 97% have frequencies of less than 1% and 46% are singletons that are present in only one individual (53% among unrelated individuals). These rare variants provide insights into mutational processes and recent human evolutionary history. The extensive catalogue of genetic variation in TOPMed studies provides unique opportunities for exploring the contributions of rare and noncoding sequence variants to phenotypic variation. Furthermore, combining TOPMed haplotypes with modern imputation methods improves the power and reach of genome-wide association studies to include variants down to a frequency of approximately 0.01%.

VL - 590 IS - 7845 ER - TY - JOUR T1 - Whole-genome association analyses of sleep-disordered breathing phenotypes in the NHLBI TOPMed program. JF - Genome Med Y1 - 2021 A1 - Cade, Brian E A1 - Lee, Jiwon A1 - Sofer, Tamar A1 - Wang, Heming A1 - Zhang, Man A1 - Chen, Han A1 - Gharib, Sina A A1 - Gottlieb, Daniel J A1 - Guo, Xiuqing A1 - Lane, Jacqueline M A1 - Liang, Jingjing A1 - Lin, Xihong A1 - Mei, Hao A1 - Patel, Sanjay R A1 - Purcell, Shaun M A1 - Saxena, Richa A1 - Shah, Neomi A A1 - Evans, Daniel S A1 - Hanis, Craig L A1 - Hillman, David R A1 - Mukherjee, Sutapa A1 - Palmer, Lyle J A1 - Stone, Katie L A1 - Tranah, Gregory J A1 - Abecasis, Goncalo R A1 - Boerwinkle, Eric A A1 - Correa, Adolfo A1 - Cupples, L Adrienne A1 - Kaplan, Robert C A1 - Nickerson, Deborah A A1 - North, Kari E A1 - Psaty, Bruce M A1 - Rotter, Jerome I A1 - Rich, Stephen S A1 - Tracy, Russell P A1 - Vasan, Ramachandran S A1 - Wilson, James G A1 - Zhu, Xiaofeng A1 - Redline, Susan AB -

BACKGROUND: Sleep-disordered breathing is a common disorder associated with significant morbidity. The genetic architecture of sleep-disordered breathing remains poorly understood. Through the NHLBI Trans-Omics for Precision Medicine (TOPMed) program, we performed the first whole-genome sequence analysis of sleep-disordered breathing.

METHODS: The study sample was comprised of 7988 individuals of diverse ancestry. Common-variant and pathway analyses included an additional 13,257 individuals. We examined five complementary traits describing different aspects of sleep-disordered breathing: the apnea-hypopnea index, average oxyhemoglobin desaturation per event, average and minimum oxyhemoglobin saturation across the sleep episode, and the percentage of sleep with oxyhemoglobin saturation < 90%. We adjusted for age, sex, BMI, study, and family structure using MMSKAT and EMMAX mixed linear model approaches. Additional bioinformatics analyses were performed with MetaXcan, GIGSEA, and ReMap.

RESULTS: We identified a multi-ethnic set-based rare-variant association (p = 3.48 × 10) on chromosome X with ARMCX3. Additional rare-variant associations include ARMCX3-AS1, MRPS33, and C16orf90. Novel common-variant loci were identified in the NRG1 and SLC45A2 regions, and previously associated loci in the IL18RAP and ATP2B4 regions were associated with novel phenotypes. Transcription factor binding site enrichment identified associations with genes implicated with respiratory and craniofacial traits. Additional analyses identified significantly associated pathways.

CONCLUSIONS: We have identified the first gene-based rare-variant associations with objectively measured sleep-disordered breathing traits. Our results increase the understanding of the genetic architecture of sleep-disordered breathing and highlight associations in genes that modulate lung development, inflammation, respiratory rhythmogenesis, and HIF1A-mediated hypoxic response.

VL - 13 IS - 1 ER - TY - JOUR T1 - Targeted Genome Sequencing Identifies Multiple Rare Variants in Caveolin-1 Associated with Obstructive Sleep Apnea. JF - Am J Respir Crit Care Med Y1 - 2022 A1 - Liang, Jingjing A1 - Wang, Heming A1 - Cade, Brian E A1 - Kurniansyah, Nuzulul A1 - He, Karen Y A1 - Lee, Jiwon A1 - Sands, Scott A A1 - Brody, Jennifer A1 - Chen, Han A1 - Gottlieb, Daniel J A1 - Evans, Daniel S A1 - Guo, Xiuqing A1 - Gharib, Sina A A1 - Hale, Lauren A1 - Hillman, David R A1 - Lutsey, Pamela L A1 - Mukherjee, Sutapa A1 - Ochs-Balcom, Heather M A1 - Palmer, Lyle J A1 - Purcell, Shaun A1 - Saxena, Richa A1 - Patel, Sanjay R A1 - Stone, Katie L A1 - Tranah, Gregory J A1 - Boerwinkle, Eric A1 - Lin, Xihong A1 - Liu, Yongmei A1 - Psaty, Bruce M A1 - Vasan, Ramachandran S A1 - Manichaikul, Ani A1 - Rich, Stephen S A1 - Rotter, Jerome I A1 - Sofer, Tamar A1 - Redline, Susan A1 - Zhu, Xiaofeng AB -

INTRODUCTION: Obstructive sleep apnea (OSA) is a common disorder associated with increased risk for cardiovascular disease, diabetes, and premature mortality. There is strong clinical and epi-demiologic evidence supporting the importance of genetic factors influencing OSA, but limited data implicating specific genes.

METHODS: Leveraging high depth genomic sequencing data from the National Heart, Lung, and Blood Institute (NHLBI) Trans-Omics for Precision Medicine (TOPMed) program and imputed genotype data from multiple population-based studies, we performed linkage analysis in the Cleve-land Family Study (CFS) followed by multi-stage gene-based association analyses in independent cohorts to search for rare variants contributing to OSA severity as assessed by the apnea-hypopnea index (AHI) in a total of 7,708 individuals of European ancestry.

RESULTS: Linkage analysis in CFS identified a suggestive linkage peak on chromosome 7q31 (LOD=2.31). Gene-based analysis identified 21 non-coding rare variants in Caveolin-1 (CAV1) associated with lower AHI after accounting for multiple comparisons (p=7.4×10-8). These non-coding variants together significantly contributed to the linkage evidence (p<10-3). Follow-up anal-ysis revealed significant associations between these variants and increased CAV1 expression, and increased CAV1 expression in peripheral monocytes was associated with lower AHI (p=0.024) and higher minimum overnight oxygen saturation (p=0.007).

CONCLUSION: Rare variants in CAV1, a membrane scaffolding protein essential in multiple cellular and metabolic functions, are associated with higher CAV1 gene expression and lower OSA severity, suggesting a novel target for modulating OSA severity.

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