Associations between sleep apnea risk and cardiovascular disease indicators among Chinese and Korean Americans

Brittany N Morey; Soomin Ryu; Yuxi Shi; Susan Redline; Ichiro Kawachi; Sunmin Lee

doi:10.1016/j.sleepe.2022.100037

Associations between sleep apnea risk and cardiovascular disease indicators among Chinese and Korean Americans

Sleep Epidemiol. 2022 Dec:2:100037. doi: 10.1016/j.sleepe.2022.100037. Epub 2022 Jul 22.

Authors

Brittany N Morey¹, Soomin Ryu², Yuxi Shi³, Susan Redline⁴, Ichiro Kawachi⁵, Sunmin Lee⁶

Affiliations

¹ Department of Health, Society, & Behavior, Program in Public Health, University of California Irvine, 653 E. Peltason Dr., Anteater Instruction and Research Building (AIRB) 2022, Irvine, CA 92697-3957, USA.
² School of Public Policy, University of Maryland, College Park, USA.
³ University of California, Irvine, USA.
⁴ Department of Medicine, and Harvard T.H. Chan School of Public Health, Department of Epidemiology, Harvard Medical School, Brigham and Women's Hospital, USA.
⁵ Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA.
⁶ Department of Medicine, School of Medicine, University of California, Irvine, USA.

Abstract

Study objectives: While sleep apnea has been associated with cardiovascular disease (CVD) risk factors in white individuals in the U.S., these associations in Chinese and Korean Americans are less well-understood, particularly how these associations vary by age, gender, Asian origin, obesity, chronic conditions, and daytime sleepiness.

Methods: We used a sample of Chinese and Korean Americans ages 50-75 (n = 394) from the Baltimore-Washington DC Metropolitan Area to examine the associations of high risk (HR) sleep apnea with diagnoseable hypercholesterolemia and diabetes, as well as the following biomarkers: total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C ratio, triglycerides, and glucose (non-fasting). Poisson models included demographic factors, socioeconomic status, and body mass index (BMI). We tested for potential effect modifiers.

Results: HR-sleep apnea was associated with higher LDL-C level (β = 14.56, p < 0.05) and higher total cholesterol/HDL ratio (β = 0.64, p < 0.01). Younger respondents had higher levels of triglycerides associated with HR-sleep apnea than older respondents. For men, HR-sleep apnea was associated with higher total cholesterol, total cholesterol/HDL-C ratio, and triglycerides. Obese and overweight respondents had positive associations between HR-sleep apnea and total cholesterol, total cholesterol/HDL ratio, and triglycerides, while underweight/normal weight individuals did not. The interactions between snoring and daytime sleepiness were associated with hypercholesterolemia and diabetes.

Conclusions: This study demonstrates associations between sleep apnea risk and dyslipidemia among Chinese and Korean Americans. Associations were particularly pronounced among younger, male, overweight/obese, and sicker individuals. Future research should examine how to improve sleep health in Asian American populations to improve CVD risk.

Keywords: Asian Americans; Cardiovascular disease; Cholesterol; Diabetes; Hypercholesterolemia; Sleep apnea.

Grants and funding

R01 MD012778/MD/NIMHD NIH HHS/United States