Sleep apnea, daytime sleepiness linked to higher coronary artery calcium scores
Patients with obstructive sleep apnea and daytime sleepiness had a 66% higher risk of atherosclerosis than those with neither condition, a Brazilian analysis found.
Obstructive sleep apnea (OSA) was independently associated with incidence and progression of coronary artery calcium (CAC) score, especially when combined with excessive daytime sleepiness, a study found.
Researchers conducted a prospective study derived from the Brazilian Longitudinal Study of Adult Health (ELSABrasil), a community-based cohort of adults ages 35 to 74 years. Participants responded to a sleepiness questionnaire and underwent actigraphy and home sleep studies at baseline. Their CAC scores were measured at baseline between 2010 and 2014, and at follow-up between 2016 and 2018. Results were published by CHEST on June 23.
There were 1,956 participants with available CAC scores at baseline, 32.4% with OSA and 23.0% with a CAC score greater than 0. Excessive daytime sleepiness occurred in 38.2%. Participants with OSA were older, were predominantly male, had a higher body mass index, and had higher prevalence of hypertension, diabetes, smoking, and hyperlipidemia. They also had higher frequency of short sleep duration, higher scores on the Epworth Sleepiness Scale, and higher CAC compared to patients without OSA.
In covariate-adjusted analyses of 1,247 patients with a mean follow-up of 5.1±0.9 years, there was a significant association between OSA and subclinical atherosclerosis (odds ratio [OR], 1.26; 95% CI, 1.06 to 1.48), with stronger effects among those reporting daytime sleepiness (OR, 1.66; 95% CI, 1.30 to 2.12 [P=0.028 for the interaction). The study authors noted that daytime sleepiness on its own was not associated with any CAC outcome. An exploratory analysis of patients in whom CAC showed a numerical increase at follow-up (n=319) showed a positive association with OSA (β=1.084; 95% CI, 0.032 to 2.136; P=0.043) and OSA with excessive daytime sleepiness (β=1.651; 95% CI, 0.208 to 3.094; P=0.025). Fully adjusted models showed no significant associations after stratification by age and sex.
The authors noted that these findings provided new evidence that OSA is a potential risk factor for subclinical coronary atherosclerosis but did not support a mediating role of excessive daytime sleepiness on the association. Instead, results suggest that sleepiness may help stratify patients with OSA where a potentially stronger mediating role of well-recognized cardiovascular risk factors are observed.
“These results underscore the need of systematically identifying patients with OSA at higher cardiovascular risk (e.g., excessively sleepy patients) that could be benefited from personalized approaches focused to maximize cardiovascular prevention,” the authors wrote.