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Obstructive sleep apnea is independently associated with subclinical coronary atherosclerosis among middle-aged women

Abstract

Purpose

Obstructive sleep apnea (OSA) is associated with coronary disease among men. However, this association is not clear for women. In this study, we evaluate the association between OSA and presence of subclinical atherosclerosis assessed by tomographic coronary calcium score in middle-aged women.

Methods

We evaluated consecutive women aged between 45 and 65 years in perimenopause or postmenopause period (with menstrual irregularity—amenorrhea > 60 days), without manifest cardiovascular disease (heart failure, coronary disease, and stroke), from two gynecologic clinics. All patients underwent clinical evaluation, computed tomographic examination for coronary artery calcium (CAC > 100 Agatston units), and portable sleep study. Multiple logistic regression models were used to evaluate the association between OSA and CAC, controlling for traditional risk factors including Framingham Risk Score (FRS), body mass index (BMI), and diabetes.

Results

We studied 214 women (age 56 years (52–61); BMI 28 kg/m2 (25–31), 25 % diabetes, 62 % hypertension). OSA (apnea-hypopnea index (AHI) ≥5 events/h) was diagnosed in 82 women (38.3 %). CAC was more prevalent in patients with moderate/severe OSA (AHI ≥15 events/h) than in patients without or with mild OSA, 19 % vs 4.5 and 1.6 %, respectively (p < 0.01). Moderate to severe OSA was associated with CAC in unadjusted (odds ratio = 6.25, 95 % CI 1.66–23.52; p < 0.01) and adjusted (odds ratio = 8.19, 95 % CI 1.66–40.32; p = 0.01) logistic regression analysis.

Conclusion

Moderate to severe OSA is independently associated with the presence of CAC in middle-aged women. These results reinforce the concept that women are also susceptible to the cardiovascular consequences of OSA.

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Abbreviations

AHI:

Apnea-hypopnea index

BMI:

Body mass index

BP:

Blood pressure

CAC:

Coronary artery calcium

CPAP:

Continuous positive airway pressure

ECG:

Electrocardiogram

ODI:

Oxygen desaturation index

OSA:

Obstructive sleep apnea

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Authors’ contributions

Ana Kelley L. Medeiros: data collection and analysis and manuscript draft

Ricardo Q. Coutinho: data collection and analysis

Isly M. L. Barros: data collection and analysis

Laura O. B. F. Costa: study design.

Ana Paula D. L. Leite: CAC evaluations

Marcio S. Bittencourt: data analysis and manuscript draft

Thais C. Lustosa: data collection

Martinha M. B. Carvalho: data collection

Maria Priscila Figueiredo Lira: data collection

Moacir N. L. Ferreira: study design

Geraldo Lorenzi-Filho: data analysis and manuscript draft

Luciano F. Drager: data analysis and manuscript draft

Rodrigo P. Pedrosa: study design, data collection and analysis, and manuscript draft

Author information

Correspondence to Rodrigo P. Pedrosa.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institute (Complexo Hospitalar-Hospital Universitário Oswaldo Cruz-Universidade de Pernambuco/UPE/Procape, Approval Number CAAE-0135.0.106.000-10) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Funding

Fundação de Amparo à Pesquisa do Estado de Pernambuco and Conselho Nacional de Desenvolvimento Científico e Tecnológico provided financial support in the form of 02 fundings.

The sponsor had no role in the design or conduct of this research.

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Cite this article

Medeiros, A.K.L., Coutinho, R.Q., Barros, I.M.L. et al. Obstructive sleep apnea is independently associated with subclinical coronary atherosclerosis among middle-aged women. Sleep Breath 21, 77–83 (2017). https://doi.org/10.1007/s11325-016-1374-4

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Keywords

  • Obstructive sleep apnea
  • Women
  • Atherosclerosis
  • Coronary heart disease