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Sleep apnea and retinal signs in cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis

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Abstract

Purpose

The aim of the study was to examine the relationship between sleep apnea, retinal vascular caliber and retinopathy, and their impact on cardiovascular disease (CVD) risk.

Methods

A multi-ethnic cohort of 5,803 participants was examined based on standardized grading of retinal vascular caliber and retinopathy from digital fundus photographs, self-reported physician-diagnosed sleep apnea (PDSA), and incident cardiovascular events.

Results

In women, PDSA was associated with narrower arterioles (regression coefficient [β] −5.76; 95 % confidence Interval [CI] −8.51, −3.02) after adjusting for cardio-metabolic risk factors. The incident rate ratio (IRR) of CVD was also associated with narrower arterioles (IRR for highest versus lowest tertile 1.91; 95 % CI 1.08, 3.38). In men, PDSA was not associated with arteriolar caliber. However, incident CVD was associated with narrower arterioles (IRR 1.67; 95 % CI 1.10, 2.52), wider venules (IRR 1.71; 95 % CI 1.13, 2.59) and PDSA (IRR 2.03, 95 % CI 1.17, 3.51). The IRR of CVD in men with PDSA increased minimally to 2.06 (95 % CI 1.18, 3.56) after adjustment for retinal arteriolar and venular caliber. Combining women and men, the IRR of CVD was 3.41 (95 % CI 1.79, 6.50) in those with both PDSA and narrower retinal arterioles.

Conclusions

Sleep apnea was associated with narrower retinal arterioles in women but not in men. However, sleep apnea was also associated with incident CVD in men. These suggest potential gender differences in susceptibility to microvascular disease in association with sleep apnea.

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Acknowledgments

The authors would like to thank the investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

Funding: This research was supported by contracts, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95167, and a grant NHLBI T32 HL076132 from the National Heart, Lung and Blood Institute. Additional support was provided by National Institute of Health grant HL69979-03 (Klein R, Wong TY).

Disclosures

None of the authors have any conflicts of interest.

Author information

Authors and Affiliations

  1. Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore

    Merwyn Chew, Tien Yin Wong & Ning Cheung

  2. Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Merwyn Chew & Tien Yin Wong

  3. Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia

    Jing Xie, Tien Yin Wong & Ning Cheung

  4. Department of Ophthalmology and Visual Science, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Ronald Klein & Barbara Klein

  5. Division of Epidemiology and Clinical Research, National Eye Institute, NIH, Bethesda, MD, USA

    Mary Frances Cotch

  6. Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Susan Redline

  7. Department of Ophthalmology, National University Health System, Singapore, Singapore

    Merwyn Chew & Tien Yin Wong

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  1. Merwyn Chew
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  2. Jing Xie
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  3. Ronald Klein
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Correspondence to Merwyn Chew.

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Chew, M., Xie, J., Klein, R. et al. Sleep apnea and retinal signs in cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis. Sleep Breath 20, 15–23 (2016). https://doi.org/10.1007/s11325-015-1177-z

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  • DOI: https://doi.org/10.1007/s11325-015-1177-z

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