Center of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, SP, Brazil.
Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS; Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS.
Chest. 2024 Jan;165(1):202-212. doi: 10.1016/j.chest.2023.06.025. Epub 2023 Jun 24.
Uncertainty exists about the impact of OSA and its phenotypes on cardiovascular disease.
Are OSA and clinical features such as daytime sleepiness associated with incident subclinical coronary atherosclerosis?
In this prospective community-based cohort study, we administered a sleepiness questionnaire, actigraphy, and home sleep studies at baseline. Coronary artery calcium (CAC; 64-slice multidetector CT scan imaging) was measured at two different time points throughout the study (baseline, between 2010 and 2014, and follow-up, between 2016 and 2018). Incidence of subclinical atherosclerosis was defined as baseline CAC of 0 followed by CAC of > 0 at a 5-year follow-up visit. The association of incident CAC outcome was assessed using logistic regression. Stratified analyses based on excessive daytime sleepiness (EDS) were performed.
We analyzed 1,956 participants with available CAC scores at baseline (mean age, 49 ± 8 years; 57.9% female; 32.4% with OSA). In covariate-adjusted analyses (n = 1,247; mean follow-up, 5.1 ± 0.9 years), we found a significant association between OSA and incidence of subclinical atherosclerosis (OR, 1.26; 95% CI, 1.06-1.48), with stronger effects among those reporting EDS (OR, 1.66; 95% CI, 1.30-2.12; P = .028 for interaction). Interestingly, EDS per se was not associated with any CAC outcome. An exploratory analysis of the square root of CAC progression (baseline CAC > 0 followed by a numerical increase in scores at follow-up; n = 319) showed a positive association for both OSA (β = 1.084; 95% CI, 0.032-2.136; P = .043) and OSA with EDS (β = 1.651; 95% CI, 0.208-3.094; P = .025).
OSA, particularly with EDS, predicts the incidence and progression of CAC. These results support biological plausibility for the increased cardiovascular risk observed among patients with OSA with excessive sleepiness.
阻塞性睡眠呼吸暂停（OSA）及其表型对心血管疾病的影响尚不确定。
OSA 和日间嗜睡等临床特征是否与亚临床冠状动脉粥样硬化的发生有关？
在这项前瞻性社区队列研究中，我们在基线时进行了嗜睡问卷、活动计和家庭睡眠研究。在整个研究过程中（基线、2010 年至 2014 年和随访、2016 年至 2018 年），通过 64 层多层螺旋 CT 扫描进行冠状动脉钙（CAC）检测。将亚临床动脉粥样硬化的发生定义为基线 CAC 为 0 但在 5 年随访时 CAC 为>0。使用逻辑回归评估 CAC 结果的发生关联。基于日间嗜睡（EDS）进行了分层分析。
我们分析了基线时 CAC 评分可获得的 1956 名参与者（平均年龄为 49±8 岁；57.9%女性；32.4%患有 OSA）。在调整协变量的分析中（n=1247；平均随访时间为 5.1±0.9 年），我们发现 OSA 与亚临床动脉粥样硬化的发生之间存在显著关联（OR，1.26；95%CI，1.06-1.48），EDS 报告者的影响更强（OR，1.66；95%CI，1.30-2.12；P=0.028 交互作用）。有趣的是，EDS 本身与任何 CAC 结果均无关。对基线 CAC>0 且随访时评分数值增加的 CAC 进展的平方根（n=319）的探索性分析显示，OSA（β=1.084；95%CI，0.032-2.136；P=0.043）和伴有 EDS 的 OSA（β=1.651；95%CI，0.208-3.094；P=0.025）均呈正相关。
OSA，尤其是伴有 EDS 的 OSA，可预测 CAC 的发生和进展。这些结果支持在伴有过度嗜睡的 OSA 患者中观察到的心血管风险增加的生物学可能性。
