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Objectively measured sleep characteristics and prevalence of coronary artery calcification: the Multi-Ethnic Study of Atherosclerosis Sleep study
  1. Pamela L Lutsey1,
  2. Robyn L McClelland2,
  3. Daniel Duprez3,
  4. Steven Shea4,
  5. Eyal Shahar5,
  6. Mako Nagayoshi6,
  7. Matthew Budoff7,
  8. Joel D Kaufman8,
  9. Susan Redline9
  1. 1Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota, USA
  2. 2Department of Biostatistics, University of Washington, Seattle, Washington, USA
  3. 3Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
  4. 4Departments of Medicine and Epidemiology, Columbia University, New York, New York, USA
  5. 5Division of Epidemiology & Biostatistics, University of Arizona, Tucson, Arizona, USA
  6. 6Department of Community Medicine, Nagasaki University, Nagasaki, Japan
  7. 7Department of Medicine, University of California—Los Angeles, Torrance, California, USA
  8. 8Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
  9. 9Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Assistant Professor Pamela L Lutsey, University of Minnesota, Division of Epidemiology and Community Health, 1300 S 2nd Street, Suite 300, Minneapolis, MN 55454, USA; Lutsey{at}


Background We tested whether objectively measured indices of obstructive sleep apnoea (OSA) and sleep quality are associated with coronary artery calcification (CAC) prevalence independent of obesity, a classic confounder.

Methods 1465 Multi-Ethnic Study of Atherosclerosis participants (mean age 68 years), who were free of clinical cardiovascular disease, had both coronary CT and in-home polysomnography and actigraphy performed. OSA categories were defined by the Apnea-Hypopnea Index (AHI). Prevalence ratios (PRs) for CAC >0 and >400 (high burden) were calculated.

Results Participants with severe OSA (AHI ≥30; 14.6%) were more likely to have prevalent CAC, relative to those with no evidence of OSA, after adjustment for demographics and smoking status (PR 1.16; 95% CI 1.06 to 1.26), body mass index (1.11; 1.02 to 1.21) and traditional cardiovascular risk factors (1.10; 1.01 to 1.19). Other markers of hypoxaemia tended to be associated with a higher prevalence of CAC >0. For CAC >400, a higher prevalence was observed with both a higher arousal index and less slow-wave sleep. Overall, associations were somewhat stronger among younger participants, but did not vary by sex or race/ethnicity.

Conclusions In this population-based multi-ethnic sample, severe OSA was associated with subclinical coronary artery disease (CAC >0), independent of obesity and traditional cardiovascular risk factors. Furthermore, the associations of the arousal index and slow-wave sleep with high CAC burden suggest that higher nightly sympathetic nervous system activation is also a risk factor. These findings highlight the potential importance of measuring disturbances in OSA as well as sleep fragmentation as possible risk factors for coronary artery disease.

  • Sleep apnoea

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