Mako Nagayoshi1, Pamela L Lutsey2, David Benkeser3, Christina L Wassel4, Aaron R Folsom2, Eyal Shahar5, Hiroyasu Iso6, Matthew A Allison7, Michael H Criqui7, Susan Redline8. 1. Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan. Electronic address: mnagayoshi@nagasaki-u.ac.jp. 2. Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA. 3. Division of Biostatistics, University of California, Berkeley, CA, USA. 4. Department of Pathology and Laboratory Medicine, College of Medicine, University of Vermont, Colchester, VT, USA. 5. Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA. 6. Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan. 7. Department of Family Medicine and Public Health, University of California, San Diego, CA, USA. 8. Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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.
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.
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