The Sleep Heart Health Study
Daniel J. Gottlieb, MD, MPH; Gayane Yenokyan, MD, PhD; Anne B. Newman, MD, MPH; George T. O'Connor, MD, MSc; Naresh M. Punjabi, MD, PhD; Stuart F. Quan, MD; Susan Redline, MD, MPH; Helaine E. Resnick, PhD, MPH; Elisa K. Tong, MD, MA; Marie Diener-West, PhD; Eyal Shahar, MD, MPH
From the VA Boston Healthcare System (D.J.G.), Boston, Mass; Boston University School of Medicine (D.J.G., G.T.O.), Boston, Mass; Johns Hopkins University (G.Y., N.M.P., M.D.-W.), Baltimore, Md; Graduate School of Public Health (A.B.N.), University of Pittsburgh, Pittsburgh, Pa; University of Arizona (S.F.Q.), Tucson, Ariz; Harvard Medical School (S.F.Q.), Boston, Mass; Case Western Reserve University (S.R.), Cleveland, Ohio; American Association of Homes and Services for the Aging and Georgetown University (H.E.R.), Washington, DC; University of California (E.K.T.), Davis, Calif; and Mel and Enid Zuckerman College of Public Health (E.S.), University of Arizona, Tucson, Ariz.
Correspondence to Daniel J. Gottlieb, MD, MPH, Boston University School of Medicine, 715 Albany St, R304, Boston, MA 02118-2394. E-mail gottlieb@bu.edu
Background— Clinic-based observational studies in men have reported that obstructive sleep apnea is associated with an increased incidence of coronary heart disease. The objective of this study was to assess the relation of obstructive sleep apnea to incident coronary heart disease and heart failure in a general community sample of adult men and women.
Methods and Results— A total of 1927 men and 2495 women 40 years of age and free of coronary heart disease and heart failure at the time of baseline polysomnography were followed up for a median of 8.7 years in this prospective longitudinal epidemiological study. After adjustment for multiple risk factors, obstructive sleep apnea was a significant predictor of incident coronary heart disease (myocardial infarction, revascularization procedure, or coronary heart disease death) only in men 70 years of age (adjusted hazard ratio 1.10 [95% confidence interval 1.00 to 1.21] per 10-unit increase in apnea-hypopnea index [AHI]) but not in older men or in women of any age. Among men 40 to 70 years old, those with AHI 30 were 68% more likely to develop coronary heart disease than those with AHI <5. Obstructive sleep apnea predicted incident heart failure in men but not in women (adjusted hazard ratio 1.13 [95% confidence interval 1.02 to 1.26] per 10-unit increase in AHI). Men with AHI 30 were 58% more likely to develop heart failure than those with AHI <5.
Conclusions— Obstructive sleep apnea is associated with an increased risk of incident heart failure in community-dwelling middle-aged and older men; its association with incident coronary heart disease in this sample is equivocal.
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