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Electrocardiographically indicated cardiovascular disease in sleep-disordered breathing

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Abstract

The evidence for a role of sleep-disordered breathing (SDB) in cardiovascular disease (CVD) is inconclusive and limited to clinic-based studies or population-based studies using historical CVD data. The authors investigated cross-sectional association of SDB, assessed by overnight polysomnography and described by frequency of apnea/hypopnea episodes (Apnea–Hypopnea Index, AHI), with screen-detected CVD consisting of cardiologist-confirmed, electrocardiographically indicated coronary artery disease (ECG-CAD), left ventricular hypertrophy (ECG-LVH), arrhythmias, and conduction abnormalities in a general population. Using multiple logistic regression with adjustments for covariables, there was no significant association of AHI with ECG-CAD, ECG-LVH by voltage, arrhythmias, or conduction abnormalities. There was, however, an association between AHI and ECG-LVH by Cornell criteria. Using AHI as categorical variable, the adjusted odds of ECG-CAD in AHI ≥ 5 vs <5 was increased, but not significantly, at 1.30, 95% confidence interval (CI) 0.67, 2.51. The adjusted odds of ECG-LVH by Cornell criteria in AHI ≥ 15 vs <5 was significant at 3.19, 95% CI 1.16, 8.76. The authors found a weak or no association between screen-detected CVD and sleep apnea, but did find a threefold increased odds of screen-detected LVH, using Cornell criteria, in moderate or worse SDB. These findings contribute to accumulating evidence of possible association between CVD and sleep apnea in the general population and underscore the need to better understand how SDB affects cardiovascular pathology.

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References

  1. Shamsuzzaman ASM, Gersh BJ, Somers VK (2003) Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 290:1906–1914

    Article  PubMed  CAS  Google Scholar 

  2. Hung J, Whitford EG, Parsons RW, Hillman DR (1990) Association of sleep apnoea with myocardial infarction in men. Lancet 336:261–264

    Article  PubMed  CAS  Google Scholar 

  3. Mooe T, Rabben T, Wiklund U, Franklin KA, Eriksson P (1996) Sleep-disordered breathing in women: occurrence and association with coronary artery disease. Am J Med 101:251–256

    Article  PubMed  CAS  Google Scholar 

  4. Mooe T, Rabben T, Wiklund U, Franklin KA, Eriksson P (1996) Sleep-disordered breathing in men with coronary artery disease. Chest 109:659–663

    Article  PubMed  CAS  Google Scholar 

  5. D’Alessandro R, Magelli C, Gamberini G, Bachhelli S, Cristina E, Magnani B, Lugaresi E (1990) Snoring every night as a risk factor for myocardial infarction: a case-control study. BMJ 300:1557–1558

    PubMed  CAS  Google Scholar 

  6. Hedner J, Ejnell H, Caidahl K (1990) Left ventricular hypertrophy independent of hypertension in patients with obstructive sleep apnoea. J Hypertens 8(10):941–946

    Article  PubMed  CAS  Google Scholar 

  7. Noda A, Okada T, Yasuma F, Nakashima N, Yokota M (1995) Cardiac hypertrophy in obstructive sleep apnea syndrome. Chest 107:1538–1544

    Article  PubMed  CAS  Google Scholar 

  8. Niroumand M, Kuperstein R, Sasson Z, Hanly PJ (2001) Impact of obstructive sleep apnea on left ventricular mass and diastolic function. Am J Respir Crit Care Med 163:1632–1636

    PubMed  CAS  Google Scholar 

  9. Hu FB, Willett WC, Colditz GA, Ascherio A, Speizer FE, Rosner B, Hennekens CH, Stampfer MJ (1999) Prospective study of snoring and risk of hypertension in women. Am J Epidemiol 150:806–816

    PubMed  CAS  Google Scholar 

  10. Cloward TV, Walker JM, Farney RJ, Anderson JL (2003) Left ventricular hypertrophy is a common echocardiographic abnormality in severe obstructive sleep apnea and reverses with nasal continuous positive airway pressure. Chest 124:594–601

    Article  PubMed  Google Scholar 

  11. Khalil MM, Rifaie OA (1998) Electrocardiographic changes in obstructive sleep apnoea syndrome. Respir Med 92:25–27

    Article  PubMed  CAS  Google Scholar 

  12. Peker Y, Hedner J, Norum J, Kraiczi H, Carlson J (2002) Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. Am J Respir Crit Care Med 166:159–165

    Article  PubMed  Google Scholar 

  13. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, O’Connor GT, Boland LL, Schwartz JE, Samet JM (2001) Sleep-disordered breathing and cardiovascular disease. Cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163:19–25

    PubMed  CAS  Google Scholar 

  14. Newman AB, Nieto FJ, Guidry U, Lind BK, Redline S, Pickering TG, Quan SF (2001) Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. Am J Epidemiol 154(1):50–59

    Article  PubMed  CAS  Google Scholar 

  15. Guidry UC, Mendes LA, Evans JC, Levy D, O’Connor GT, Larson MG, Gottlieb DJ, Benjamin EJ (2001) Echocardiographic features of the right heart in sleep-disordered breathing: the Framingham Heart Study. Am J Respir Crit Care Med 164:933–8

    PubMed  CAS  Google Scholar 

  16. Drager LF, Bortolotto LA, Lorenzi MC, Figueiredo AC, Krieger EM, Lorenzi-Filho G (2005) Early signs of atherosclerosis in obstructive sleep apnea. Am J Resp Crit Care Med 172:613–618

    Article  PubMed  Google Scholar 

  17. Nieto FJ, Herrington DM, Redline S, Benjamin EJ, Robbins JA (2004) Sleep apnea and markers of vascular endothelial function in a large community sample of older adults. Am J Respir Crit Care Med 169:354–360

    Article  PubMed  Google Scholar 

  18. Faulx MD, Larkin EK, Hoit BD, Aylor JE, Wright AT, Redline S (2004) Sex influences endothelial function in sleep-disordered breathing. SLEEP 27(6):1113–1120

    PubMed  Google Scholar 

  19. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  PubMed  CAS  Google Scholar 

  20. Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P (1987) Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation 75:565–572

    PubMed  CAS  Google Scholar 

  21. Furberg CD, Manolio TA, Psaty BM, Bild DE, Borhani NO, Newman A, Tabatznik B, Rautaharju PM (1992) Major electrocardiographic abnormalities in persons aged 65 years and older (the Cardiovascular Health Study). Am J Cardiol 69(16):1329–1335

    Article  PubMed  CAS  Google Scholar 

  22. Rechtschaffen A, Kales A (1968) A manual of standardized terminology techniques and scoring system for sleep stages of human subjects. Public Health Service, US Government Printing Office, Los Angeles, CA

    Google Scholar 

  23. American Society of Hypertension (1992) Recommendations for routine blood pressure measurement by cuff sphygmomanometry. Am J Hypertens 5:207–209

    Google Scholar 

  24. De Bacquer D, De Backer G, Kornitzer M (2000) Prevalences of ECG findings in large population based samples of men and women. Heart 84:625–633

    Article  PubMed  Google Scholar 

  25. Hanly P, Sasson Z, Zuberi N, Lunn K (1993) ST-segment depression during sleep in obstructive sleep apnea. Am J Cardiol 71:1341–1345

    Article  PubMed  CAS  Google Scholar 

  26. Kannel WB, Anderson K, McGee DL, Degatano LS, Stampfer MJ (1987) Nonspecific electrocardiographic abnormality as a predictor for coronary heart diseases: tThe Framingham Study. Am Heart J 113:370–376

    Article  PubMed  CAS  Google Scholar 

  27. de Bruyne MC, Kors JA, Hoes AW, Kruijssen DA, Deckers JW, Grosfeld M, van Herpen G, Grobbee DE, Van Bemmel JH (1997) Diagnostic interpretation of electrocardiograms in population-based research: computer program, research physicians, or cardiologists. J Clin Epidemiol 50(8):947–952

    Article  PubMed  Google Scholar 

  28. Otto ME, Belohlavek M, Romero-Corral A, Gami AS, Gilman G, Svatikova A, Amin RS, Lopez-Jimennez F, Khanderia BK, Somers VK (2007) Comparison of cardiac structural and functional changes in obese otherwise healthy adults with versus without obstructive sleep apnea. Am J Cardiol 99(9):1298–1302

    Article  PubMed  Google Scholar 

  29. Dimsdale JE, Coy T, Ziegler MG, Ancoli-Israel S, Clausen J (1995) The effect of sleep apnea on plasma and urinary catecholamines. Sleep 18:377–381

    PubMed  CAS  Google Scholar 

  30. Somers VK, Dyken ME, Clary MP, Abboud FM (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 96:1897–1904

    Article  PubMed  CAS  Google Scholar 

  31. Schulz R, Schmidt D, Blum A, Lopes-Ribeiro X, Lucke C, Mayer K, Oschewski H, Seeger W, Grimminger F (2000) Decreased plasma levels of nitric oxide derivatives in obstructive sleep apnoea: response to CPAP therapy. Thorax 55:1046–1051

    Article  PubMed  CAS  Google Scholar 

  32. Kato M, Roberts-Thomson P, Phillips BG, Haynes WG, Winnicki M, Accurso V, Somers VK (2000) Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea. Circulation 102:2607–2610

    PubMed  CAS  Google Scholar 

  33. Schulz R, Mahmoudi S, Hattar K, Sibelius U, Olschewski H, Mayer K, Seeger W, Grimminger F (2000) Enhanced release of superoxide from polymorphonuclear neutrophils in obstructive sleep apnea: impact of continuous positive airway pressure therapy. Am J Respir Crit Care Med 162:566–570

    PubMed  CAS  Google Scholar 

  34. Shamsuzzaman AS, Winnicki M, Lanfranchi P, Wolk R, Kara T, Accurso V, Somers VK (2002) Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 105:2462–2464

    Article  PubMed  CAS  Google Scholar 

  35. El-Solh AA, Mador MJ, Sikka P, Dhillon RS, Ámsterdam D, Grant BJ (2002) Adhesion molecules in patients with coronary artery disease and moderate-to-severe obstructive sleep apnea. Chest 121:1541–1547

    Article  PubMed  CAS  Google Scholar 

  36. Sanner BM, Konermann M, Tepel M, Groetz J, Mummenhoff C, Zidek W (2000) Platelet function in patients with obstructive sleep apnoea syndrome. Eur Respir J 16:648–652

    Article  PubMed  CAS  Google Scholar 

  37. Phillips BG, Kato M, Narkiewicz K, Choe I, Somers VK (2000) Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea. Am J Physiol Heart Circ Physiol 279:H234–H237

    PubMed  CAS  Google Scholar 

  38. Hla KM, Skatrud JB, Finn L, Palta M, Young T (2002) The effect of correction of sleep-disordered breathing on BP in untreated hypertension. Chest 122:1125–1132

    Article  PubMed  Google Scholar 

  39. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384

    Article  PubMed  CAS  Google Scholar 

  40. Becker HF, Jerrentrup A, Ploch T, Grote L, Penzel T, Sullivan CE, Peter JH (2003) Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 107:68–73

    Article  PubMed  Google Scholar 

  41. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, Mullins R, Jenkinson C, Stradling JR, Davies RJ (2002) Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomized parallel trial. Lancet 359(9302):204–210

    Article  PubMed  Google Scholar 

  42. Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Leiby BE, Vela-Bueno A, Kales A (2000) Association of hypertension and sleep-disordered breathing. Arch Intern Med 160(15):2289–2295

    Article  PubMed  CAS  Google Scholar 

  43. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D’Agostino RB, Newman AB, Lebowitz MD, Pickering TG (2000) Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 284(14):1829–1836

    Article  Google Scholar 

  44. Young T, Peppard P, Palta M, Hla KM, Finn L, Morgan B, Skatrud J (1997) Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 157:1746–1752

    Article  PubMed  CAS  Google Scholar 

  45. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JR Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ (2003) The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 289:2560–2572

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors are indebted to Diane Austin, Linda Evans, Kathryn Pluff, Andrea Peterson, Diane Dowd, Katherine Kenison, Mary Sundstrom, and Robin Stubbs for their contributions and technical assistance.

Funding

This work was supported by the National Institutes of Health grants: RO1 65525, RR03186, and AG14124-05.

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Authors and Affiliations

  1. Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Khin Mae Hla & David Ende

  2. Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Khin Mae Hla, Terry Young, Laurel A. Finn, Paul E. Peppard & Timothy J. Kinsey

  3. Section of General Internal Medicine, 2828 Marshall Ct., Suite 100, Madison, WI, 53705, USA

    Khin Mae Hla

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  1. Khin Mae Hla
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Correspondence to Khin Mae Hla.

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Hla, K.M., Young, T., Finn, L.A. et al. Electrocardiographically indicated cardiovascular disease in sleep-disordered breathing. Sleep Breath 12, 251–258 (2008). https://doi.org/10.1007/s11325-007-0168-0

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