Abstract MP68: Risk of Sleep Apnea and Subclinical Cardiovascular Disease in Young-to-Middle Aged Adults: The Bogalusa Heart Study

Abstract

Obstructive sleep apnea (OSA) may affect cardiovascular risk. Prior studies examining this issue have often been limited to patients in clinical settings or older adults. Given the high prevalence of obstructive sleep apnea in middle-aged adults and the influence of duration of OSA on cardiovascular risk, examining subclinical cardiovascular in middle aged-adults would further elucidate the direct relationship between OSA and cardiovascular disease. We examined the association between risk of OSA and subclinical cardiovascular disease indicators among 914 young-to-middle aged adults who responded to the Berlin Questionnaire assessment of OSA risk in 2010, and had measures of carotid intima-media thickness (IMT) and left ventricular (LV) geometry. Carotid IMT was measured using standard procedures and categorized into quartiles. Indices of LV geometry were assessed by M-mode echocardiography and classified into normal, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy by integrating gender and race specific relative wall thickness and LV mass index. High-risk for OSA was determined using Berlin Questionnaire score as the primary outcome. Secondary outcomes included habitual snoring and excessive sleepiness. Of those included in the analysis, mean (SD) age was 43.1 (4.5) yrs; 42.1% were male and 31.7% were Black. A total of 235 (25.7%) participants had elevated Berlin scores indicating high-risk for OSA. Mean (SD) of carotid IMT was 0.66 (0.15) mm, and 87 (9.5%) and 161 (17.6%) participants had eccentric and concentric LV hypertrophy, respectively. In log-linear regression models adjusted for age, race, sex, education, current smoking, regular alcohol consumption, total cholesterol, high-density lipoprotein cholesterol, and type-2 diabetes, participants at high-risk of OSA were 1.35 (95% CI: 1.07 - 1.71) times more likely to be in the highest quartile of IMT (≥0.74 mm), were 1.68 (1.09 - 2.58) times as likely to have concentric hypertrophy, and 1.64 (0.95 - 2.82) times as likely to have eccentric hypertrophy, compared to those at low-risk of OSA. Similar positive associations were observed for habitual snoring but not for excessive sleepiness. After further adjusting for current obesity status in the models, the association of OSA risk with IMT remained consistent while the associations with LV hypertrophy was attenuated. There was no significant effect modification by race or sex. In summary, being at high risk OSA was associated with substantially higher risk of subclinical cardiovascular disease in this biracial, semi-rural, community-based population of young-to-middle age adults.