Jingwei Li1,2,3, Danni Zheng3,4, Kelly A Loffler5, Xia Wang3, R Doug McEvoy5, Richard J Woodman6, Yuanming Luo7, Geraldo Lorenzi-Filho8, Ferran Barbe9, Manjari Tripathi10, Craig S Anderson3,11,12,13,14. 1. Department of Cardiology, People's Liberation Army General Hospital, Beijing, China. 2. Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China. 3. The 211065George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia. 4. Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia. 5. The Adelaide Institute for Sleep Health, College of Medicine and Public Health, 1065Flinders University, Adelaide, Australia. 6. Centre for Biostatistics and Epidemiology, College of Medicine and Public Health, 1065Flinders University, Adelaide, Australia. 7. The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, China. 8. Heart Institute, Instituto do Coracao, University of Sao Paulo, Sao Paulo, Brazil. 9. Respiratory Department, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Institutde Recerca Biomèdica de Lleida, Madrid, Spain. 10. Department of Neurology, 28730All India Institute of Medical Sciences, New Delhi, India. 11. The George Institute China, Peking University Health Science Center, Beijing, China. 12. Neurology Department, 2205Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, Australia. 13. Heart Health Research Center, Beijing, China. 14. Center for Clinical Studies, School of Medicine-Clínica Alemana, Instituto de Ciencias e Innovación en Medicina, Universidad del Desarrollo, Santiago, Chile.
Abstract
BACKGROUND AND AIM: Controversy exists regarding cardiovascular risk in relation to sleep duration. We determined sleep duration and major recurrent cardiovascular event associations in patients with obstructive sleep apnoea and established cardiovascular disease. METHODS: Secondary analyses of the international, multicenter, Sleep Apnea Cardiovascular Endpoints trial. Sleep duration was estimated from overnight home oximetry (ApneaLink monitor) used for obstructive sleep apnoea diagnosis. Cox proportional hazards models were used to determine associations of categorized sleep duration (<6 h, 6-8 h (reference), and >8 h) and major cardiovascular outcomes: primary composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and any hospitalization for unstable angina, heart failure, or transient ischemic attack; secondary composite of cardiac and cerebral (stroke/transient ischemic attack) events. RESULTS: Oximetry-derived sleep duration estimates were available in 2687 participants (mean 61.2 years, 80.9% males) who experienced a total of 436 cardiovascular events over a mean follow-up of 3.7 years. Compared to the reference category, sleep duration was not associated with risk of the primary composite cardiovascular outcome (adjusted hazard ratio (HR) 1.00, 95% confidence interval 0.76-1.33, and HR 1.22, 95% confidence interval 0.98-1.52, for sleep duration <6 and >8 h, respectively). However, long sleep was associated with increased cerebral events (HR 1.67, 95% confidence interval 1.17-2.39; P = 0.005) and stroke alone (HR 1.79, 95% confidence interval 1.22-2.63; P = 0.003). CONCLUSIONS: Long sleep duration is associated with an increased risk of stroke but not cardiac events in obstructive sleep apnoea patients with existing cardiovascular disease. CLINICAL TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (NCT00738179).
BACKGROUND AND AIM: Controversy exists regarding cardiovascular risk in relation to sleep duration. We determined sleep duration and major recurrent cardiovascular event associations in patients with obstructive sleep apnoea and established cardiovascular disease. METHODS: Secondary analyses of the international, multicenter, Sleep Apnea Cardiovascular Endpoints trial. Sleep duration was estimated from overnight home oximetry (ApneaLink monitor) used for obstructive sleep apnoea diagnosis. Cox proportional hazards models were used to determine associations of categorized sleep duration (<6 h, 6-8 h (reference), and >8 h) and major cardiovascular outcomes: primary composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and any hospitalization for unstable angina, heart failure, or transient ischemic attack; secondary composite of cardiac and cerebral (stroke/transient ischemic attack) events. RESULTS: Oximetry-derived sleep duration estimates were available in 2687 participants (mean 61.2 years, 80.9% males) who experienced a total of 436 cardiovascular events over a mean follow-up of 3.7 years. Compared to the reference category, sleep duration was not associated with risk of the primary composite cardiovascular outcome (adjusted hazard ratio (HR) 1.00, 95% confidence interval 0.76-1.33, and HR 1.22, 95% confidence interval 0.98-1.52, for sleep duration <6 and >8 h, respectively). However, long sleep was associated with increased cerebral events (HR 1.67, 95% confidence interval 1.17-2.39; P = 0.005) and stroke alone (HR 1.79, 95% confidence interval 1.22-2.63; P = 0.003). CONCLUSIONS: Long sleep duration is associated with an increased risk of stroke but not cardiac events in obstructive sleep apnoeapatients with existing cardiovascular disease. CLINICAL TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (NCT00738179).