Sleep-disordered Breathing and Cardiovascular Disease

TLDR

Sleep‑disordered breathing is linked to acute cardiovascular dysfunction, yet its association with chronic cardiovascular disease remains under‑explored. This study examined the cross‑sectional relationship between sleep‑disordered breathing and self‑reported cardiovascular disease in 6,424 community‑dwelling adults who underwent overnight, unattended polysomnography. Sleep‑disordered breathing was quantified by the apnea–hypopnea index derived from home polysomnography, and multivariable models compared AHI quartiles with self‑reported CVD outcomes. Mild to moderate sleep‑disordered breathing was common (median AHI 4.4) and associated with a modestly increased odds of CVD, particularly heart failure and stroke, with higher AHI quartiles showing 1.28–1.42 times the odds of prevalent CVD compared to the lowest quartile.

Abstract

Disordered breathing during sleep is associated with acute, unfavorable effects on cardiovascular physiology, but few studies have examined its postulated association with cardiovascular disease (CVD). We examined the cross-sectional association between sleep- disordered breathing and self-reported CVD in 6,424 free-living individuals who underwent overnight, unattended polysomnography at home. Sleep-disordered breathing was quantified by the apnea–hypopnea index (AHI)—the average number of apneas and hypopneas per hour of sleep. Mild to moderate disordered breathing during sleep was highly prevalent in the sample (median AHI: 4.4; interquartile range: 1.3 to 11.0). A total of 1,023 participants (16%) reported at least one manifestation of CVD (myocardial infarction, angina, coronary revascularization procedure, heart failure, or stroke). The multivariable-adjusted relative odds (95% CI) of prevalent CVD for the second, third, and fourth quartiles of the AHI (versus the first) were 0.98 (0.77–1.24), 1.28 (1.02–1.61), and 1.42 (1.13–1.78), respectively. Sleep-disordered breathing was associated more strongly with self-reported heart failure and stroke than with self-reported coronary heart disease: the relative odds (95% CI) of heart failure, stroke, and coronary heart disease (upper versus lower AHI quartile) were 2.38 (1.22–4.62), 1.58 (1.02– 2.46), and 1.27 (0.99–1.62), respectively. These findings are compatible with modest to moderate effects of sleep-disordered breathing on heterogeneous manifestations of CVD within a range of AHI values that are considered normal or only mildly elevated.