Independent association between obstructive sleep apnea and subclinical coronary artery disease

Dan Sorajja, Apoor S. Gami, Virend Somers, Thomas R. Behrenbeck, Arturo Garcia-Touchard, Francisco Lopez-Jimenez

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

Background: Obstructive sleep apnea (OSA) is associated with coronary risk factors, but it is unknown if OSA is associated with development of coronary disease. We evaluated the association between OSA and the presence of subclinical coronary disease assessed by coronary artery calcification (CAC). Methods: Consecutive patients with no history of coronary disease who underwent electron-beam CT within 3 years of polysomnography between March 1991 and December 2003 were included. OSA was defined by an apnea-hypopnea index (AHI) ≥ 5 events per hour, and patients were grouped by quartiles of AHI severity. Logistic regression modeled the association between OSA severity and presence of CAC. Results: There were 202 patients (70% male; median age, 50 years; mean body mass index, 32 kg/m2; 8% diabetic; 9% current smokers; 60% hypercholesterolemic; and 47% hypertensive). OSA was present in 76%. CAC was present in 67% of OSA patients and 31% of non-OSA patients (p < 0.001). Median CAC scores (Agatston units) were 9 in OSA patients and 0 in non-OSA patients (p < 0.001). Median CAC score was higher as OSA severity increased (p for trend by AHI quartile < 0.001). With multivariate adjustment, the odds ratio for CAC increased with OSA severity. Using the first AHI quartile as reference, the adjusted odds ratios for the second, third, and fourth quartiles were 2.1 (p = 0.12), 2.4 (p = 0.06), and 3.3 (p = 0.03), respectively. Conclusions: In patients without clinical coronary disease, the presence and severity of OSA is independently associated with the presence and extent of CAC OSA identifies patients at risk for coronary disease and may represent a highly prevalent modifiable risk factor.

Original languageEnglish (US)
Pages (from-to)927-933
Number of pages7
JournalChest
Volume133
Issue number4
DOIs
StatePublished - Apr 2008

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Obstructive Sleep Apnea
Coronary Artery Disease
Coronary Vessels
Coronary Disease
Apnea
Sleep Apnea Syndromes
Odds Ratio
Polysomnography
Body Mass Index
Logistic Models
Electrons

Keywords

  • Calcium
  • Coronary artery disease
  • Obstructive sleep apnea
  • Risk factors

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Independent association between obstructive sleep apnea and subclinical coronary artery disease. / Sorajja, Dan; Gami, Apoor S.; Somers, Virend; Behrenbeck, Thomas R.; Garcia-Touchard, Arturo; Lopez-Jimenez, Francisco.

In: Chest, Vol. 133, No. 4, 04.2008, p. 927-933.

Research output: Contribution to journalArticle

Sorajja, Dan ; Gami, Apoor S. ; Somers, Virend ; Behrenbeck, Thomas R. ; Garcia-Touchard, Arturo ; Lopez-Jimenez, Francisco. / Independent association between obstructive sleep apnea and subclinical coronary artery disease. In: Chest. 2008 ; Vol. 133, No. 4. pp. 927-933.
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title = "Independent association between obstructive sleep apnea and subclinical coronary artery disease",
abstract = "Background: Obstructive sleep apnea (OSA) is associated with coronary risk factors, but it is unknown if OSA is associated with development of coronary disease. We evaluated the association between OSA and the presence of subclinical coronary disease assessed by coronary artery calcification (CAC). Methods: Consecutive patients with no history of coronary disease who underwent electron-beam CT within 3 years of polysomnography between March 1991 and December 2003 were included. OSA was defined by an apnea-hypopnea index (AHI) ≥ 5 events per hour, and patients were grouped by quartiles of AHI severity. Logistic regression modeled the association between OSA severity and presence of CAC. Results: There were 202 patients (70{\%} male; median age, 50 years; mean body mass index, 32 kg/m2; 8{\%} diabetic; 9{\%} current smokers; 60{\%} hypercholesterolemic; and 47{\%} hypertensive). OSA was present in 76{\%}. CAC was present in 67{\%} of OSA patients and 31{\%} of non-OSA patients (p < 0.001). Median CAC scores (Agatston units) were 9 in OSA patients and 0 in non-OSA patients (p < 0.001). Median CAC score was higher as OSA severity increased (p for trend by AHI quartile < 0.001). With multivariate adjustment, the odds ratio for CAC increased with OSA severity. Using the first AHI quartile as reference, the adjusted odds ratios for the second, third, and fourth quartiles were 2.1 (p = 0.12), 2.4 (p = 0.06), and 3.3 (p = 0.03), respectively. Conclusions: In patients without clinical coronary disease, the presence and severity of OSA is independently associated with the presence and extent of CAC OSA identifies patients at risk for coronary disease and may represent a highly prevalent modifiable risk factor.",
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AU - Sorajja, Dan

AU - Gami, Apoor S.

AU - Somers, Virend

AU - Behrenbeck, Thomas R.

AU - Garcia-Touchard, Arturo

AU - Lopez-Jimenez, Francisco

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N2 - Background: Obstructive sleep apnea (OSA) is associated with coronary risk factors, but it is unknown if OSA is associated with development of coronary disease. We evaluated the association between OSA and the presence of subclinical coronary disease assessed by coronary artery calcification (CAC). Methods: Consecutive patients with no history of coronary disease who underwent electron-beam CT within 3 years of polysomnography between March 1991 and December 2003 were included. OSA was defined by an apnea-hypopnea index (AHI) ≥ 5 events per hour, and patients were grouped by quartiles of AHI severity. Logistic regression modeled the association between OSA severity and presence of CAC. Results: There were 202 patients (70% male; median age, 50 years; mean body mass index, 32 kg/m2; 8% diabetic; 9% current smokers; 60% hypercholesterolemic; and 47% hypertensive). OSA was present in 76%. CAC was present in 67% of OSA patients and 31% of non-OSA patients (p < 0.001). Median CAC scores (Agatston units) were 9 in OSA patients and 0 in non-OSA patients (p < 0.001). Median CAC score was higher as OSA severity increased (p for trend by AHI quartile < 0.001). With multivariate adjustment, the odds ratio for CAC increased with OSA severity. Using the first AHI quartile as reference, the adjusted odds ratios for the second, third, and fourth quartiles were 2.1 (p = 0.12), 2.4 (p = 0.06), and 3.3 (p = 0.03), respectively. Conclusions: In patients without clinical coronary disease, the presence and severity of OSA is independently associated with the presence and extent of CAC OSA identifies patients at risk for coronary disease and may represent a highly prevalent modifiable risk factor.

AB - Background: Obstructive sleep apnea (OSA) is associated with coronary risk factors, but it is unknown if OSA is associated with development of coronary disease. We evaluated the association between OSA and the presence of subclinical coronary disease assessed by coronary artery calcification (CAC). Methods: Consecutive patients with no history of coronary disease who underwent electron-beam CT within 3 years of polysomnography between March 1991 and December 2003 were included. OSA was defined by an apnea-hypopnea index (AHI) ≥ 5 events per hour, and patients were grouped by quartiles of AHI severity. Logistic regression modeled the association between OSA severity and presence of CAC. Results: There were 202 patients (70% male; median age, 50 years; mean body mass index, 32 kg/m2; 8% diabetic; 9% current smokers; 60% hypercholesterolemic; and 47% hypertensive). OSA was present in 76%. CAC was present in 67% of OSA patients and 31% of non-OSA patients (p < 0.001). Median CAC scores (Agatston units) were 9 in OSA patients and 0 in non-OSA patients (p < 0.001). Median CAC score was higher as OSA severity increased (p for trend by AHI quartile < 0.001). With multivariate adjustment, the odds ratio for CAC increased with OSA severity. Using the first AHI quartile as reference, the adjusted odds ratios for the second, third, and fourth quartiles were 2.1 (p = 0.12), 2.4 (p = 0.06), and 3.3 (p = 0.03), respectively. Conclusions: In patients without clinical coronary disease, the presence and severity of OSA is independently associated with the presence and extent of CAC OSA identifies patients at risk for coronary disease and may represent a highly prevalent modifiable risk factor.

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KW - Risk factors

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