Longitudinal association between sleep disordered breathing and peripheral artery disease in the Wisconsin sleep cohort

Abstract

BACKGROUND— Sleep-disordered breathing (SDB) is associated with clinical cardiovascular disease (CVD) but its association with subclinical atherosclerosis has only been studied in cross-sectional studies. OBJECTIVE— To examine the longitudinal association between SDB and markers of subclinical peripheral arterial disease (PAD) among community dwelling adults. METHODS— We used prospective data from the participants in the Wisconsin Sleep Cohort (n=1,491, 54% female, 30-79 yrs at baseline). The ankle-brachial index (ABI) was defined as the ratio of systolic blood pressure in the ankle/brachial arteries; an ABI RESULTS— Compared with no SDB, the age, sex, and BMI-adjusted 8-yr change in ABI in those with mild, moderate, and severe SDB were -0.001, -0.005, and -0.037 (p=0.02), respectively. The association persisted after further adjustment for waist/hip ratio, hypertension, diabetes, smoking, alcohol, cholesterol, and history of clinical CVD, and was stronger among participants ≥55 yrs. The adjusted hazard ratio of incident PAD comparing severe SDB to no SDB was 1.5, but was not statistically significant, due to the small number of events. CONCLUSIONS— Severe SDB was associated with significant decline in ABI, a marker of peripheral artery disease, but only weakly with PAD incidence.