Obstructive Sleep Apnea and 15-Year Cognitive Decline: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Sleep apnea has been associated with diabetes in many cross-sectional studies, but prospective data is sparse. Most prior studies defined sleep apnea by self-reported sleep symptoms. Hypothesis: Objectively measured obstructive sleep apnea is associated with greater risk of incident diabetes. Design: We conducted a prospective cohort study of 1,465 non-diabetic participants of the Sleep Heart Health-Atherosclerosis Risk in Communities Study with in-home polysomnography conducted in 1996-1998 (baseline). Participants were categorized into four groups according to number of events per hour, as defined by the apnea-hypopnea index: <5.0 (normal), 5.0-14.9 (mild sleep apnea), 15.0-29.9 (moderate sleep apnea), and ≥30.0 (severe sleep apnea). Incident diagnosed diabetes or diabetes medication use was ascertained during annual follow-up calls through 2010. Cox proportional hazards models were used to examine the association between sleep apnea severity and incident diagnosed diabetes. Results: During a median follow-up of 12 years, there were 279 incident self-reported diabetes cases among the study participants (mean age 63 years, 99% white, 47% male). The risk of diabetes among those with moderate or severe sleep apnea was significantly higher than in those without sleep apnea after adjustment for demographics measures and other confounders. The association persisted among those with severe sleep apnea even after adjustment for body mass index and waist circumference. Across all models there was evidence of a dose-response association between the sleep apnea severity and the risk of incident diabetes ( Table ). There was no evidence for an interaction by sex. Conclusions: In this community-based study, persons with objectively measured obstructive severe sleep apnea were at higher risk of diabetes compared to persons without sleep apnea, independent of body mass index and waist circumference. Screening and treatment of sleep apnea may be beneficial for the prevention of diabetes.

Download Full-text

Obstructive Sleep Apnea, Other Sleep Characteristics, and Risk of CKD in the Atherosclerosis Risk in Communities Sleep Heart Health Study

Journal of the American Society of Nephrology ◽

10.1681/asn.2020010024 ◽

2020 ◽

Vol 31 (8) ◽

pp. 1859-1869 ◽

Cited By ~ 1

Author(s):

Kelsie M. Full ◽

Chandra L. Jackson ◽

Casey M. Rebholz ◽

Kunihiro Matsushita ◽

Pamela L. Lutsey

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Apnea Hypopnea Index ◽

Lifestyle Behaviors ◽

Atherosclerosis Risk In Communities ◽

Obstructive Sleep Apnea Severity ◽

Obstructive Sleep ◽

Increased Risk ◽

Ckd Stage ◽

Atherosclerosis Risk

BackgroundObstructive sleep apnea may be associated with development of CKD through hypoxia, inflammation, and oxidative stress. Individuals with this sleep disorder are also at increased risk for established CKD risk factors, including obesity, hypertension, and type 2 diabetes.MethodsWe examined the association between obstructive sleep apnea, other sleep characteristics, and risk of incident CKD (stage 3 or higher) in 1525 participants (mean age, 62.5 years; 52.4% women) in the Atherosclerosis Risk in Communities (ARIC) study who completed in-home polysomnography assessments. We used the apnea-hypopnea index (events per hour) to define obstructive sleep apnea severity (normal, <5.0; mild, 5.0–14.9; moderate, 15.0–29.9; and severe, ≥30.0) and defined incident CKD (stage 3 or higher) as eGFR<60 ml/min per 1.73 m2 and ≥25% decline from baseline, CKD-related hospitalization or death, or ESKD. Cox proportional hazards regression was used to estimate obstructive sleep apnea severity with risk of incident CKD, adjusting for demographics, lifestyle behaviors, and cardiometabolic conditions.ResultsDuring 19 years (median) of follow-up, 461 CKD events occurred. After adjustment for demographics and lifestyle behaviors, severe obstructive sleep apnea associated with increased risk of CKD (hazard ratio [HR], 1.51; 95% confidence interval [95% CI], 1.08 to 2.10), which was attenuated after adjustment for body mass index (HR, 1.07; 95% CI, 0.75 to 1.52). No other sleep characteristics associated with incident CKD.ConclusionsWe found a link between obstructive sleep apnea and an elevated risk of stage 3 CKD or higher, but this association was no longer significant after adjusting for obesity, a risk factor for both conditions. Given the high prevalence of obstructive sleep apnea and CKD among adults, further investigation is warranted.

Download Full-text