Association of sleep apnea and sleep duration with peripheral artery disease

The Multi-Ethnic Study of Atherosclerosis (MESA)

Mako Nagayoshi, Pamela L. Lutsey, David Benkeser, Christina L. Wassel, Aaron R. Folsom, Eyal Shahar, Hiroyasu Iso, Matthew A. Allison, Michael H. Criqui, Susan Redline

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background and aims Numerous biological pathways linking sleep disturbances to atherosclerosis have been identified, such as insulin resistance, inflammation, hypertension, and endothelial dysfunction. Yet, the association of sleep apnea and sleep duration with peripheral artery disease (PAD) is not well characterized. Methods We evaluated the cross-sectional association between objectively measured sleep and prevalent PAD in 1844 participants (mean age 68 years) who in 2010–2013 had in-home polysomnography, 7-day wrist actigraphy and ankle-brachial index (ABI) measurements. We also evaluated the relation between self-reported diagnosed sleep apnea and PAD incidence in 5365 participants followed from 2000 to 2012. PAD was defined as ABI < 0.90. Results In cross-sectional analyses, severe sleep apnea [apnea-hypopnea index (AHI) ≥30 vs. AHI <5] was associated with greater prevalent PAD only among black participants [multivariate adjusted prevalence ratio (95% CI): 2.29 (1.07–4.89); p-interaction = 0.05]. Short and long sleep duration was also associated with a 2-fold higher prevalence of PAD as compared with those who slept 7 h/night, in the full sample. In longitudinal analyses, participants with self-reported diagnosed sleep apnea were at higher risk of incident PAD [multivariable adjusted hazard ratio (95% CI): 1.93 (1.05–3.53)], with no evidence of interaction by race/ethnicity. Conclusions These findings support a significant association between sleep apnea and prevalent and incident PAD, with evidence for stronger associations with objectively measured sleep apnea and cross sectional PAD in blacks. In addition, short and long sleep duration was associated with PAD. These results identify sleep disturbances as a potential risk factor for PAD.

Original languageEnglish (US)
Pages (from-to)467-475
Number of pages9
JournalAtherosclerosis
Volume251
DOIs
StatePublished - Aug 1 2016

Fingerprint

Peripheral Arterial Disease
Sleep Apnea Syndromes
Atherosclerosis
Sleep
Ankle Brachial Index
Apnea
Actigraphy
Polysomnography
Wrist
Insulin Resistance
Cross-Sectional Studies
Hypertension
Inflammation

Keywords

  • Community-based study
  • Epidemiology
  • Longitudinal study
  • Obstructive sleep apnea
  • Peripheral artery disease
  • Sleep duration

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of sleep apnea and sleep duration with peripheral artery disease : The Multi-Ethnic Study of Atherosclerosis (MESA). / Nagayoshi, Mako; Lutsey, Pamela L.; Benkeser, David; Wassel, Christina L.; Folsom, Aaron R.; Shahar, Eyal; Iso, Hiroyasu; Allison, Matthew A.; Criqui, Michael H.; Redline, Susan.

In: Atherosclerosis, Vol. 251, 01.08.2016, p. 467-475.

Research output: Contribution to journalArticle

Nagayoshi, M, Lutsey, PL, Benkeser, D, Wassel, CL, Folsom, AR, Shahar, E, Iso, H, Allison, MA, Criqui, MH & Redline, S 2016, 'Association of sleep apnea and sleep duration with peripheral artery disease: The Multi-Ethnic Study of Atherosclerosis (MESA)', Atherosclerosis, vol. 251, pp. 467-475. https://doi.org/10.1016/j.atherosclerosis.2016.06.040
Nagayoshi, Mako ; Lutsey, Pamela L. ; Benkeser, David ; Wassel, Christina L. ; Folsom, Aaron R. ; Shahar, Eyal ; Iso, Hiroyasu ; Allison, Matthew A. ; Criqui, Michael H. ; Redline, Susan. / Association of sleep apnea and sleep duration with peripheral artery disease : The Multi-Ethnic Study of Atherosclerosis (MESA). In: Atherosclerosis. 2016 ; Vol. 251. pp. 467-475.
@article{42e46e2a1e7441abafceedbb3ffcdba3,
title = "Association of sleep apnea and sleep duration with peripheral artery disease: The Multi-Ethnic Study of Atherosclerosis (MESA)",
abstract = "Background and aims Numerous biological pathways linking sleep disturbances to atherosclerosis have been identified, such as insulin resistance, inflammation, hypertension, and endothelial dysfunction. Yet, the association of sleep apnea and sleep duration with peripheral artery disease (PAD) is not well characterized. Methods We evaluated the cross-sectional association between objectively measured sleep and prevalent PAD in 1844 participants (mean age 68 years) who in 2010–2013 had in-home polysomnography, 7-day wrist actigraphy and ankle-brachial index (ABI) measurements. We also evaluated the relation between self-reported diagnosed sleep apnea and PAD incidence in 5365 participants followed from 2000 to 2012. PAD was defined as ABI < 0.90. Results In cross-sectional analyses, severe sleep apnea [apnea-hypopnea index (AHI) ≥30 vs. AHI <5] was associated with greater prevalent PAD only among black participants [multivariate adjusted prevalence ratio (95{\%} CI): 2.29 (1.07–4.89); p-interaction = 0.05]. Short and long sleep duration was also associated with a 2-fold higher prevalence of PAD as compared with those who slept 7 h/night, in the full sample. In longitudinal analyses, participants with self-reported diagnosed sleep apnea were at higher risk of incident PAD [multivariable adjusted hazard ratio (95{\%} CI): 1.93 (1.05–3.53)], with no evidence of interaction by race/ethnicity. Conclusions These findings support a significant association between sleep apnea and prevalent and incident PAD, with evidence for stronger associations with objectively measured sleep apnea and cross sectional PAD in blacks. In addition, short and long sleep duration was associated with PAD. These results identify sleep disturbances as a potential risk factor for PAD.",
keywords = "Community-based study, Epidemiology, Longitudinal study, Obstructive sleep apnea, Peripheral artery disease, Sleep duration",
author = "Mako Nagayoshi and Lutsey, {Pamela L.} and David Benkeser and Wassel, {Christina L.} and Folsom, {Aaron R.} and Eyal Shahar and Hiroyasu Iso and Allison, {Matthew A.} and Criqui, {Michael H.} and Susan Redline",
year = "2016",
month = "8",
day = "1",
doi = "10.1016/j.atherosclerosis.2016.06.040",
language = "English (US)",
volume = "251",
pages = "467--475",
journal = "Atherosclerosis",
issn = "0021-9150",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Association of sleep apnea and sleep duration with peripheral artery disease

T2 - The Multi-Ethnic Study of Atherosclerosis (MESA)

AU - Nagayoshi, Mako

AU - Lutsey, Pamela L.

AU - Benkeser, David

AU - Wassel, Christina L.

AU - Folsom, Aaron R.

AU - Shahar, Eyal

AU - Iso, Hiroyasu

AU - Allison, Matthew A.

AU - Criqui, Michael H.

AU - Redline, Susan

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background and aims Numerous biological pathways linking sleep disturbances to atherosclerosis have been identified, such as insulin resistance, inflammation, hypertension, and endothelial dysfunction. Yet, the association of sleep apnea and sleep duration with peripheral artery disease (PAD) is not well characterized. Methods We evaluated the cross-sectional association between objectively measured sleep and prevalent PAD in 1844 participants (mean age 68 years) who in 2010–2013 had in-home polysomnography, 7-day wrist actigraphy and ankle-brachial index (ABI) measurements. We also evaluated the relation between self-reported diagnosed sleep apnea and PAD incidence in 5365 participants followed from 2000 to 2012. PAD was defined as ABI < 0.90. Results In cross-sectional analyses, severe sleep apnea [apnea-hypopnea index (AHI) ≥30 vs. AHI <5] was associated with greater prevalent PAD only among black participants [multivariate adjusted prevalence ratio (95% CI): 2.29 (1.07–4.89); p-interaction = 0.05]. Short and long sleep duration was also associated with a 2-fold higher prevalence of PAD as compared with those who slept 7 h/night, in the full sample. In longitudinal analyses, participants with self-reported diagnosed sleep apnea were at higher risk of incident PAD [multivariable adjusted hazard ratio (95% CI): 1.93 (1.05–3.53)], with no evidence of interaction by race/ethnicity. Conclusions These findings support a significant association between sleep apnea and prevalent and incident PAD, with evidence for stronger associations with objectively measured sleep apnea and cross sectional PAD in blacks. In addition, short and long sleep duration was associated with PAD. These results identify sleep disturbances as a potential risk factor for PAD.

AB - Background and aims Numerous biological pathways linking sleep disturbances to atherosclerosis have been identified, such as insulin resistance, inflammation, hypertension, and endothelial dysfunction. Yet, the association of sleep apnea and sleep duration with peripheral artery disease (PAD) is not well characterized. Methods We evaluated the cross-sectional association between objectively measured sleep and prevalent PAD in 1844 participants (mean age 68 years) who in 2010–2013 had in-home polysomnography, 7-day wrist actigraphy and ankle-brachial index (ABI) measurements. We also evaluated the relation between self-reported diagnosed sleep apnea and PAD incidence in 5365 participants followed from 2000 to 2012. PAD was defined as ABI < 0.90. Results In cross-sectional analyses, severe sleep apnea [apnea-hypopnea index (AHI) ≥30 vs. AHI <5] was associated with greater prevalent PAD only among black participants [multivariate adjusted prevalence ratio (95% CI): 2.29 (1.07–4.89); p-interaction = 0.05]. Short and long sleep duration was also associated with a 2-fold higher prevalence of PAD as compared with those who slept 7 h/night, in the full sample. In longitudinal analyses, participants with self-reported diagnosed sleep apnea were at higher risk of incident PAD [multivariable adjusted hazard ratio (95% CI): 1.93 (1.05–3.53)], with no evidence of interaction by race/ethnicity. Conclusions These findings support a significant association between sleep apnea and prevalent and incident PAD, with evidence for stronger associations with objectively measured sleep apnea and cross sectional PAD in blacks. In addition, short and long sleep duration was associated with PAD. These results identify sleep disturbances as a potential risk factor for PAD.

KW - Community-based study

KW - Epidemiology

KW - Longitudinal study

KW - Obstructive sleep apnea

KW - Peripheral artery disease

KW - Sleep duration

UR - http://www.scopus.com/inward/record.url?scp=84979498513&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84979498513&partnerID=8YFLogxK

U2 - 10.1016/j.atherosclerosis.2016.06.040

DO - 10.1016/j.atherosclerosis.2016.06.040

M3 - Article

VL - 251

SP - 467

EP - 475

JO - Atherosclerosis

JF - Atherosclerosis

SN - 0021-9150

ER -