SLEEP - The Relationship Between Obstructive Sleep Apnea and Self-Reported Stroke or Coronary Heart Disease in Overweight and Obese Adults with Type 2 Diabetes Mellitus

VOLUME 35, ISSUE 09

OSA AND CVD IN OVERWEIGHT/OBESE ADULTS WITH TYPE 2 DIABETES MELLITUS
The Relationship Between Obstructive Sleep Apnea and Self-Reported Stroke or Coronary Heart Disease in Overweight and Obese Adults with Type 2 Diabetes Mellitus

http://dx.doi.org/10.5665/sleep.2090

Thomas B. Rice, MD, MS¹; Gary D. Foster, PhD²; Mark H. Sanders, MD¹; Mark Unruh, MD, MSc¹; David Reboussin, PhD³; Samuel T. Kuna, MD⁴; Richard Millman, MD⁵; Gary Zammit, PhD⁶; Rena R. Wing, PhD⁵; Thomas A. Wadden, PhD⁴; David Kelley, MD⁷; Xavier Pi-Sunyer, MD⁸; Anne B. Newman, MD, MPH¹

¹University of Pittsburgh, Pittsburgh, PA (MHS: retired); ²Temple University, Philadelphia, PA; ³Wake Forrest University, Winston-Salem, NC; ⁴University of Pennsylvania, Philadelphia, PA; ⁵Brown University, Providence, RI; ⁶Clinilabs, New York, NY; ⁷Merck and Company, Whitehouse Station, NJ; ⁸Columbia University, New York, NY

Table of Contents

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Study Objectives:

Type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) are common, increasingly recognized as comorbid conditions, and individually implicated in the development of cardiovascular disease (CVD). We sought to determine the association between OSA and CVD in an overweight and obese population with T2DM.

Design:

Cross-sectional.

Setting:

Ancillary study to the Look AHEAD trial.

Participants:

Three hundred five participants of the Sleep AHEAD study who underwent unattended full polysomnography at home with measurement of the apnea-hypopnea index (AHI).

Measurements and Results:

Self-reported prevalent CVD was obtained at the initial assessment of the parent study and included a history of the following conditions: stroke, carotid endarterectomy, myocardial infarction, coronary artery bypass grafting, and percutaneous coronary intervention. Logistic regression was used to assess the association of OSA, measured continuously and categorically, with prevalent CVD. OSA was present (AHI ≥ 5) in 86% of the population, whereas the prevalence of all forms of CVD was just 14%. The AHI was associated with stroke with an adjusted odds ratio (95% confidence interval) of 2.57 (1.03, 6.42). Neither the continuously measured AHI nor the categories of OSA severity were significantly associated with the other forms of CVD assessed.

Conclusions:

We found suggestive evidence of a greater prevalence of stroke at greater values of the AHI. OSA was not associated with prevalent coronary heart disease in the Sleep AHEAD trial. Future studies should confirm the link between OSA and stroke and examine mechanisms that link OSA to stroke in adults with T2DM.

Citation:

Rice TB; Foster GD; Sanders MH; Unruh M; Reboussin D; Kuna ST; Millman R; Zammit G; Wing RR; Wadden TA; Kelley D; Pi-Sunyer X; Newman AB. The relationship between obstructive sleep apnea and self-reported stroke or coronary heart disease in overweight and obese adults with type 2 diabetes mellitus. SLEEP 2012;35(9):1293-1298.