Prospective Study of Obstructive Sleep Apnea and Incident Coronary Heart Disease and Heart Failure

TLDR

Obstructive sleep apnea has been linked to higher coronary heart disease incidence in clinic‑based male cohorts. This study aimed to evaluate the association between obstructive sleep apnea and new coronary heart disease and heart failure in a community‑based cohort of men and women. The researchers followed 4,422 adults aged ≥40, free of cardiovascular disease at baseline, for a median of 8.7 years after polysomnography. In men ≤70, higher apnea‑hypopnea index predicted coronary heart disease (68% higher risk for AHI ≥ 30) and heart failure (58% higher risk for AHI ≥ 30), whereas no significant associations were found in women or older men, indicating that obstructive sleep apnea increases heart failure risk in middle‑aged and older men but its link to coronary heart disease remains uncertain.

Abstract

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 ≥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 ≤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 ≥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 ≥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.