Association between sleep apnea, snoring, incident cardiovascular events and all-cause mortality in an adult population: MESA

Abstract

Background: We assessed the association between sleep apnea, snoring, incident cardiovascular (CV) events and all-cause mortality in the Multi Ethnic Study of Atherosclerosis (MESA) cohort.

Methods: Out of 5338 respondents to a sleep questionnaire administered during the second MESA exam period, 208 had physician diagnosed sleep apnea (PDSA), 1452 were habitual snorers (HS) and 3678 were neither a habitual snorer nor had PDSA (normal participants). Cox proportional hazard analysis was used to assess the associations adjusting for age, gender, race/ethnicity, smoking, diabetes mellitus, total cholesterol, HDL, triglycerides, BMI, current alcohol use, benzodiazepine use, BP medications and statin use.

Results: Over a 7.5 year average follow-up period, 310 adjudicated CV events including MI, stroke, angina, resuscitated cardiac arrest, stroke death and CVD death and 189 deaths occurred. Compared to HS, PDSA was associated with higher incident CV rates in both univariate and multivariable models [hazard ratio (95%); 1.89 (1.22-2.93), p = 0.004 and 1.91 (1.20-3.04), p = 0.007, respectively]. PDSA was also associated with a higher death rates compared with HS [hazard ratio (95%); 2.13 (1.25-3.63), p = 0.006 and 2.70 (1.52-4.79), p = 0.007, respectively]. Compared with normal participants, PDSA had higher incident CV event rates in both univariate and multivariable models [hazard ratio (95%); 2.23 [1.39-3.60], p = 0.001 and 2.16 [1.30-3.58], p = 0.003, respectively]. Similarly, PDSA had a higher death rate compared with normal participants in both the univariate and multivariable models [hazard ratio (95% CI); 2.44 (1.36-4.37), p = 0.003 and 2.71 (1.45-5.08), p =0 .002, respectively]. Habitual snorers had similar incident CV event rates and death rates in both univariate and multivariable models compared with normal participants.

Conclusion: PDSA but not habitual snoring was associated with high incident CV events and all-cause mortality in a multi-ethnic population based study of adults free of clinical CV disease at baseline.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1

Kaplan Meier curves showing the event free survival (without incident cardiovascular events) of participants with physician diagnosed sleep apnea, habitual snorers, and normal participants in MESA.

Figure 2

Kaplan Meier curves showing the event free survival of participants with physician diagnosed sleep apnea, habitual snorers, and normal participants and all-cause mortality in MESA.

Figure 3

Association of physician diagnosed sleep apnea with incident cardiovascular event in stratified multivariable Cox proportional hazard regression model in MESA.

Figure 4

Association of physician diagnosed sleep apnea and all-cause mortality in stratified multivariable Cox proportional hazard regression models in MESA.