Markers of cardiovascular disease risk in sleep-disordered breathing with or without comorbidities: the Nagahama study

Yoshinari Nakatsuka; Kimihiko Murase; Takeshi Matsumoto; Yasuharu Tabara; Isuzu Nakamoto; Takuma Minami; Naomi Takahashi; Hirofumi Takeyama; Osamu Kanai; Satoshi Hamada; Kiminobu Tanizawa; Tomohiro Handa; Tomoko Wakamura; Naoko Komenami; Satoshi Morita; Takeo Nakayama; Toyohiro Hirai; Fumihiko Matsuda; Kazuo Chin

doi:10.5664/jcsm.9460

Markers of cardiovascular disease risk in sleep-disordered breathing with or without comorbidities: the Nagahama study

J Clin Sleep Med. 2021 Dec 1;17(12):2467-2475. doi: 10.5664/jcsm.9460.

Authors

Yoshinari Nakatsuka¹, Kimihiko Murase¹, Takeshi Matsumoto², Yasuharu Tabara³, Isuzu Nakamoto⁴, Takuma Minami⁵, Naomi Takahashi¹, Hirofumi Takeyama¹, Osamu Kanai⁶, Satoshi Hamada⁷, Kiminobu Tanizawa⁸, Tomohiro Handa⁷, Tomoko Wakamura⁴, Naoko Komenami⁹, Satoshi Morita¹⁰, Takeo Nakayama¹¹, Toyohiro Hirai⁸, Fumihiko Matsuda³, Kazuo Chin¹

Affiliations

¹ Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
² Department of Respiratory Medicine, Saiseikai Noe Hospital, Osaka, Japan.
³ Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁴ Nursing Science, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁵ Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁶ Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
⁷ Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁸ Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁹ Department of Food and Nutrition, Kyoto Women's University, Kyoto, Japan.
¹⁰ Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
¹¹ Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan.

Abstract

Study objectives: Whether the association between sleep-disordered breathing (SDB) and cardiovascular disease is independent of comorbid risk factors for cardiovascular disease is controversial. The objective of this study was to elucidate whether the association between SDB severity and the surrogate markers of cardiovascular disease events differs in relation to the number of comorbidities.

Methods: This cross-sectional study included 7,731 participants. Severity of SDB was determined by the oxygen desaturation index adjusted by actigraph-measured objective sleep time. Participants were stratified according to SDB severity and the number of comorbidities (hypertension, diabetes, dyslipidemia, and obesity), and the associations between the maximum value of intima-media thickness of the common carotid artery (CCA-IMT-max), brachial-ankle pulse wave velocity, and cardio-ankle vascular index were evaluated.

Results: Among participants with no risk factors, CCA-IMT-max increased according to SDB severity (n = 1022, P < .0001). Even after matching the background, the median CCA-IMT-max value was 14% higher in moderate-severe SDB patients than those without SDB (n = 45 in each group, P = .020). The difference was not significant for brachial-ankle pulse wave velocity and cardio-ankle vascular index. On the other hand, a significant difference in CCA-IMT-max was not found in those with multiple comorbidities. Consistently, multiple regression analysis revealed an independent association between CCA-IMT-max and moderate-severe SDB for all study participants (β: 0.0222, 95% confidence interval: 0.0039-0.0405, P = .017), but the association was not significant for stratified participants with multiple comorbidities.

Conclusions: SDB severity is associated with the CCA-IMT-max level, but the independent association becomes weaker for those with multiple comorbidities.

Citation: Nakatsuka Y, Murase K, Matsumoto T, et al. Markers of cardiovascular disease risk in sleep-disordered breathing with or without comorbidities: the Nagahama Study. J Clin Sleep Med. 2021;17(12):2467-2475.

Keywords: cardiovascular diseases; clinical epidemiology; sleep apnea.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Ankle Brachial Index
Biomarkers
Cardiovascular Diseases* / epidemiology
Carotid Intima-Media Thickness
Cross-Sectional Studies
Humans
Pulse Wave Analysis
Risk Factors
Sleep Apnea Syndromes* / complications
Sleep Apnea Syndromes* / epidemiology

Substances

Biomarkers