Incident Coronary Calcium Score in Patients With OSA With and Without Excessive Sleepiness: Brazilian Longitudinal Study of Adult Health

Abstract

Uncertainty exists about the impact of OSA and its phenotypes on cardiovascular disease. Are OSA and clinical features such as daytime sleepiness associated with incident subclinical coronary atherosclerosis? In this prospective community-based cohort study, we administered a sleepiness questionnaire, actigraphy, and home sleep studies at baseline. Coronary artery calcium (CAC; 64-slice multidetector CT scan imaging) was measured at two different time points throughout the study (baseline, between 2010 and 2014, and follow-up, between 2016 and 2018). Incidence of subclinical atherosclerosis was defined as baseline CAC of 0 followed by CAC of > 0 at a 5-year follow-up visit. The association of incident CAC outcome was assessed using logistic regression. Stratified analyses based on excessive daytime sleepiness (EDS) were performed. We analyzed 1,956 participants with available CAC scores at baseline (mean age, 49 ± 8 years; 57.9%female; 32.4%with OSA). In covariate-adjusted analyses (n= 1,247; mean follow-up, 5.1 ± 0.9 years), we found a significant association between OSA and incidence of subclinical atherosclerosis (OR, 1.26; 95%CI, 1.06-1.48), with stronger effects among those reporting EDS (OR, 1.66; 95%CI, 1.30-2.12; P= .028 for interaction). Interestingly, EDS per se was not associated with any CAC outcome. An exploratory analysis of the square root of CAC progression (baseline CAC > 0 followed by a numerical increase in scores at follow-up; n= 319) showed a positive association for both OSA (β= 1.084; 95%CI, 0.032-2.136; P= .043) and OSA with EDS (β= 1.651; 95%CI, 0.208-3.094; P= .025). OSA, particularly with EDS, predicts the incidence and progression of CAC. These results support biological plausibility for the increased cardiovascular risk observed among patients with OSA with excessive sleepiness.