The Experts below are selected from a list of 9783 Experts worldwide ranked by ideXlab platform
Terry Young - One of the best experts on this subject based on the ideXlab platform.
-
coronary heart disease incidence in sleep Disordered Breathing the wisconsin sleep cohort study
Sleep, 2015Co-Authors: Khin Mae Hla, Terry Young, Erika W Hagen, Laurel Finn, Javier F Nieto, James H Stein, Paul E PeppardAbstract:Study objectives The aim of the study was to determine the association of objectively measured sleep Disordered Breathing (SDB) with incident coronary heart disease (CHD) or heart failure (HF) in a nonclinical population. Design Longitudinal analysis of a community-dwelling cohort followed up to 24 y. Setting Sleep laboratory at the Clinical Research Unit of the University of Wisconsin Hospital and Clinics. Participants There were 1,131 adults who completed one or more overnight polysomnography studies, were free of CHD or HF at baseline, were not treated by continuous positive airway pressure (CPAP), and followed over 24 y. Interventions None. Measurements and results In-laboratory overnight polysomnography was used to assess SDB, defined by the apnea-hypopnea index (AHI) using apnea and hypopnea events per hour of sleep. Incident CHD or HF was defined by new reports of myocardial infarction, coronary revascularization procedures, congestive heart failure, and cardiovascular deaths. We used baseline AHI as the predictor variable in survival analysis models predicting CHD or HF incidence adjusted for traditional confounders. The incidence of CHD or HF was 10.9/1,000 person-years. The mean time to event was 11.2 ± 5.8 y. After adjusting for age, sex, body mass index, and smoking, estimated hazard ratios (95% confidence interval) of incident CHD or HF were 1.5 (0.9-2.6) for AHI > 0-5, 1.9 (1.05-3.5) for AHI 5 ≤ 15, 1.8 (0.85-4.0) for AHI 15 ≤ 30, and 2.6 (1.1-6.1) for AHI > 30 compared to AHI = 0 (P trend = 0.02). Conclusions Participants with untreated severe sleep Disordered Breathing (AHI > 30) were 2.6 times more likely to have an incident coronary heart disease or heart failure compared to those without sleep Disordered Breathing. Our findings support the postulated adverse effects of sleep Disordered Breathing on coronary heart disease and heart failure.
-
increased prevalence of sleep Disordered Breathing in adults
American Journal of Epidemiology, 2013Co-Authors: Paul E Peppard, Terry Young, Mari Palta, Jodi H Barnet, Erika W Hagen, Khin Mae HlaAbstract:Sleep-Disordered Breathing is a common disorder with a range of harmful sequelae. Obesity is a strong causal factor for sleep-Disordered Breathing, and because of the ongoing obesity epidemic, previous estimates of sleep-Disordered Breathing prevalence require updating. We estimated the prevalence of sleep-Disordered Breathing in the United States for the periods of 1988–1994 and 2007–2010 using data from the Wisconsin Sleep Cohort Study, an ongoing community-based study that was established in 1988 with participants randomly selected from an employed population of Wisconsin adults. A total of 1,520 participants who were 30–70 years of age had baseline polysomnography studies to assess the presence of sleep-Disordered Breathing. Participants were invited for repeat studies at 4-year intervals. The prevalence of sleep-Disordered Breathing was modeled as a function of age, sex, and body mass index, and estimates were extrapolated to US body mass index distributions estimated using data from the National Health and Nutrition Examination Survey. The current prevalence estimates of moderate to severe sleep-Disordered Breathing (apnea-hypopnea index, measured as events/hour, ≥15) are 10% (95% confidence interval (CI): 7, 12) among 30–49-year-old men; 17% (95% CI: 15, 21) among 50–70-year-old men; 3% (95% CI: 2, 4) among 30–49-year-old women; and 9% (95% CI: 7, 11) among 50–70 year-old women. These estimated prevalence rates represent substantial increases over the last 2 decades (relative increases of between 14% and 55% depending on the subgroup).
-
Sleep-Disordered Breathing and cardiovascular disease: an outcome-based definition of hypopneas.
American Journal of Respiratory and Critical Care Medicine, 2008Co-Authors: Naresh M. Punjabi, Terry Young, Helaine E Resnick, Anne B Newman, Mark H. SandersAbstract:Rationale: Epidemiologic studies on the consequences of sleep-Disordered Breathing invariably use the apnea–hypopnea index as the primary measure of disease severity. Although hypopneas constitute a majority of Disordered Breathing events, significant controversy remains about the best criteria used to define these events.Objectives: The current investigation sought to assess the most appropriate definition for hypopneas that would be best correlated with cardiovascular disease.Methods: A community sample of middle-aged and older adults was recruited as part of the Sleep Heart Health Study. Full-montage polysomnography was conducted and hypopneas were defined using different thresholds of oxyhemoglobin desaturation with and without arousals. Prevalent cardiovascular disease was assessed based on self-report. Logistic regression analysis was used to characterize the independent association between the hypopnea index and prevalent cardiovascular disease.Measurements and Main Results: Using a sample of 6,106...
-
association of sleep Disordered Breathing and the occurrence of stroke
American Journal of Respiratory and Critical Care Medicine, 2005Co-Authors: Michael Arzt, Terry Young, Laurel Finn, James B. Skatrud, Douglas T BradleyAbstract:Rationale: Sleep-Disordered Breathing has been linked to stroke in previous studies. However, these studies either used surrogate markers of sleep-Disordered Breathing or could not, due to cross-sectional design, address the temporal relationship between sleep-Disordered Breathing and stroke. Objectives: To determine whether sleep-Disordered Breathing increases the risk for stroke. Methods: We performed cross-sectional and longitudinal analyses on 1,475 and 1,189 subjects, respectively, from the general population. Sleep-Disordered Breathing was defined by the apnea–hypopnea index (frequency of apneas and hypopneas per hour of sleep) obtained by attended polysomnography. The protocol, including polysomnography, risk factors for stroke, and a history of physician-diagnosed stroke, was repeated at 4-yr intervals. Measurements and Main Results: In the cross-sectional analysis, subjects with an apnea–hypopnea index of 20 or greater had increased odds for stroke (odds ratio, 4.33; 95% confidence interval, 1.32–14.24; p = 0.02) compared with those without sleep-Disordered Breathing (apnea–hypopnea index, <5) after adjustment for known confounding factors. In the prospective analysis, sleep-Disordered Breathing with an apnea–hypopnea index of 20 or greater was associated with an increased risk of suffering a first-ever stroke over the next 4 yr (unadjusted odds ratio, 4.31; 95% confidence interval, 1.31–14.15; p = 0.02). However, after adjustment for age, sex, and body mass index, the odds ratio was still elevated, but was no longer significant (3.08; 95% confidence interval, 0.74–12.81; p = 0.12). Conclusions: These data demonstrate a strong association between moderate to severe sleep-Disordered Breathing and prevalent stroke, independent of confounding factors. They also provide the first prospective evidence that sleep-Disordered Breathing precedes stroke and may contribute to the development of stroke.
-
excess weight and sleep Disordered Breathing
Journal of Applied Physiology, 2005Co-Authors: Terry Young, Paul E Peppard, Shahrad TaheriAbstract:Excess weight is a well-established predictor of sleep-Disordered Breathing (SDB). Clinical observations and population studies throughout the United States, Europe, Asia, and Australia have consis...
Susan Redline - One of the best experts on this subject based on the ideXlab platform.
-
sleep Disordered Breathing and fibroblast growth factor 23 in the hispanic community health study study of latinos
Bone, 2018Co-Authors: Rupal Mehta, Susan Redline, Alexander Hodakowski, Bharat Thyagarajan, Donglin Zeng, William K Wohlgemuth, James P Lash, Myles Wolf, Tamara IsakovaAbstract:Abstract Preclinical data suggest that hypoxia stimulates fibroblast growth factor 23 (FGF23) transcription and cleavage in osteocytes, resulting in elevated circulating c-terminal (cFGF23) levels but normal intact FGF23 (iFGF23) levels. We conducted a case-control study within the Hispanic Community Health Study/Study of Latinos to investigate whether sleep Disordered Breathing, as a model of hypoxemia, is independently associated with elevated cFGF23 levels in the general population and with elevated cFGF23 and iFGF23 levels in patients with chronic kidney disease (CKD), in whom FGF23 cleavage may be impaired. Cases (n = 602) had severe sleep Disordered Breathing defined as an apnea/hypopnea index (AHI) of ≥30. Controls without severe sleep Disordered Breathing (n = 602) were matched for sex and CKD stage. The median AHI in the cases was 45.8 (IQR 35.5–62.5) compared to 2.6 (IQR 0.6–8.2) in the controls. Cases had higher cFGF23 levels than controls (66.2 RU/mL, IQR 52.8–98.4 vs. 61.2 RU/mL, IQR 49.5–80.1, p value
-
central sleep Disordered Breathing predicts incident atrial fibrillation in older men
American Journal of Respiratory and Critical Care Medicine, 2016Co-Authors: Anna M May, Susan Redline, Katie L Stone, Terri Blackwell, Peter H Stone, Peggy M Cawthon, William H Sauer, Paul D Varosy, Reena MehraAbstract:Rationale: Although research supports a sleep-Disordered Breathing and atrial fibrillation association, prospective data examining sleep-Disordered Breathing predicting incident atrial fibrillation are lacking.Objectives: To investigate sleep-Disordered Breathing indices as predictors of incident atrial fibrillation.Methods: A cohort (n = 843) of ambulatory older men without prevalent atrial fibrillation was assessed for baseline sleep indices: apnea–hypopnea index, central sleep apnea (central apnea index, ≥5 vs. <5), central sleep apnea or Cheyne-Stokes respiration, obstructive apnea–hypopnea index, and percentage of sleep time with less than 90% oxygen saturation. Incident clinically symptomatic adjudicated or self-reported atrial fibrillation outcome was ascertained (mean follow-up, 6.5 ± 0.7 yr). We used logistic regression models adjusted for age, race, body mass index, cardiopulmonary disease, alcohol use, pacemaker, cholesterol, cardiac medications, and alternate apnea type for obstructive and cen...
-
sleep Disordered Breathing hypoxia and risk of mild cognitive impairment and dementia in older women
JAMA, 2011Co-Authors: Kristine Yaffe, Susan Redline, Sonia Ancoliisrael, Kristine E Ensrud, Alison Laffan, Stephanie L Harrison, Adam P Spira, Katie L StoneAbstract:Context Sleep-Disordered Breathing (characterized by recurrent arousals from sleep and intermittent hypoxemia) is common among older adults. Cross-sectional studies have linked sleep-Disordered Breathing to poor cognition; however, it remains unclear whether sleep-Disordered Breathing precedes cognitive impairment in older adults. Objectives To determine the prospective relationship between sleep-Disordered Breathing and cognitive impairment and to investigate potential mechanisms of this association. Design, Setting, and Participants Prospective sleep and cognition study of 298 women without dementia (mean [SD] age: 82.3 [3.2] years) who had overnight polysomnography measured between January 2002 and April 2004 in a substudy of the Study of Osteoporotic Fractures. Sleep-Disordered Breathing was defined as an apnea-hypopnea index of 15 or more events per hour of sleep. Multivariate logistic regression was used to determine the independent association of sleep-Disordered Breathing with risk of mild cognitive impairment or dementia, adjusting for age, race, body mass index, education level, smoking status, presence of diabetes, presence of hypertension, medication use (antidepressants, benzodiazepines, or nonbenzodiazepine anxiolytics), and baseline cognitive scores. Measures of hypoxia, sleep fragmentation, and sleep duration were investigated as underlying mechanisms for this relationship. Main Outcome Measures Adjudicated cognitive status (normal, dementia, or mild cognitive impairment) based on data collected between November 2006 and September 2008. Results Compared with the 193 women without sleep-Disordered Breathing, the 105 women (35.2%) with sleep-Disordered Breathing were more likely to develop mild cognitive impairment or dementia (31.1% [n = 60] vs 44.8% [n = 47]; adjusted odds ratio [AOR], 1.85; 95% confidence interval [CI], 1.11-3.08). Elevated oxygen desaturation index (≥15 events/hour) and high percentage of sleep time (>7%) in apnea or hypopnea (both measures of Disordered Breathing) were associated with risk of developing mild cognitive impairment or dementia (AOR, 1.71 [95% CI, 1.04-2.83] and AOR, 2.04 [95% CI, 1.10-3.78], respectively). Measures of sleep fragmentation (arousal index and wake after sleep onset) or sleep duration (total sleep time) were not associated with risk of cognitive impairment. Conclusion Among older women, those with sleep-Disordered Breathing compared with those without sleep-Disordered Breathing had an increased risk of developing cognitive impairment.
-
sleep Disordered Breathing hypoxia and risk of mild cognitive impairment and dementia in older women
JAMA, 2011Co-Authors: Kristine Yaffe, Susan Redline, Sonia Ancoliisrael, Kristine E Ensrud, Alison Laffan, Stephanie L Harrison, Adam P Spira, Katie L StoneAbstract:Context Sleep-Disordered Breathing (characterized by recurrent arousals from sleep and intermittent hypoxemia) is common among older adults. Cross-sectional studies have linked sleep-Disordered Breathing to poor cognition; however, it remains unclear whether sleep-Disordered Breathing precedes cognitive impairment in older adults. Objectives To determine the prospective relationship between sleep-Disordered Breathing and cognitive impairment and to investigate potential mechanisms of this association. Design, Setting, and Participants Prospective sleep and cognition study of 298 women without dementia (mean [SD] age: 82.3 [3.2] years) who had overnight polysomnography measured between January 2002 and April 2004 in a substudy of the Study of Osteoporotic Fractures. Sleep-Disordered Breathing was defined as an apnea-hypopnea index of 15 or more events per hour of sleep. Multivariate logistic regression was used to determine the independent association of sleep-Disordered Breathing with risk of mild cognitive impairment or dementia, adjusting for age, race, body mass index, education level, smoking status, presence of diabetes, presence of hypertension, medication use (antidepressants, benzodiazepines, or nonbenzodiazepine anxiolytics), and baseline cognitive scores. Measures of hypoxia, sleep fragmentation, and sleep duration were investigated as underlying mechanisms for this relationship. Main Outcome Measures Adjudicated cognitive status (normal, dementia, or mild cognitive impairment) based on data collected between November 2006 and September 2008. Results Compared with the 193 women without sleep-Disordered Breathing, the 105 women (35.2%) with sleep-Disordered Breathing were more likely to develop mild cognitive impairment or dementia (31.1% [n = 60] vs 44.8% [n = 47]; adjusted odds ratio [AOR], 1.85; 95% confidence interval [CI], 1.11-3.08). Elevated oxygen desaturation index (≥15 events/hour) and high percentage of sleep time (>7%) in apnea or hypopnea (both measures of Disordered Breathing) were associated with risk of developing mild cognitive impairment or dementia (AOR, 1.71 [95% CI, 1.04-2.83] and AOR, 2.04 [95% CI, 1.10-3.78], respectively). Measures of sleep fragmentation (arousal index and wake after sleep onset) or sleep duration (total sleep time) were not associated with risk of cognitive impairment. Conclusion Among older women, those with sleep-Disordered Breathing compared with those without sleep-Disordered Breathing had an increased risk of developing cognitive impairment.
-
prospective study of sleep Disordered Breathing and hypertension the sleep heart health study
American Journal of Respiratory and Critical Care Medicine, 2009Co-Authors: George T Oconnor, Susan Redline, Helaine E Resnick, Anne B Newman, Stuart F. Quan, Brian S. Caffo, David M. Rapoport, Jonathan M Samet, Eyal ShaharAbstract:Rationale: Cross-sectional epidemiologic studies show an association between sleep-Disordered Breathing and hypertension, but only one cohort study has examined sleep-Disordered Breathing as a risk factor for incident hypertension. Objectives: To examine whether sleep-Disordered Breathing increases the risk of incident hypertension among persons 40 years of age and older. Methods: In a prospective cohort study, we analyzed data from 2,470 participants who at baseline did not have hypertension, defined as blood pressure of at least 140/90 mm Hg or taking antihypertensive medication. The apnea-hypopnea index (AHI), the number of apneas plus hypopneas per hour of sleep, was measured by overnight in-home polysomnography. We estimated odds ratios for developing hypertension during 5 years of follow-up according to baseline AHI. Measurements and Main Results: The odds ratios for incident hypertension increased with increasing baseline AHI; however, this relationship was attenuated and not statistically significant after adjustment for baseline body-mass index. Although not statistically significant, the observed association between a baseline AHI greater than 30 and future hypertension (odds ratio, 1.51; 95% confidence interval, 0.93–2.47) does not exclude the possibility of a modest association. Conclusions: Among middle-aged and older persons without hypertension, much of the relationship between AHI and risk of incident hypertension was accounted for by obesity. After adjustment for body mass index, the AHI was not a significant predictor of future hypertension, although a modest influence of an AHI greater than 30 on hypertension could not be excluded.
Mari Palta - One of the best experts on this subject based on the ideXlab platform.
-
increased prevalence of sleep Disordered Breathing in adults
American Journal of Epidemiology, 2013Co-Authors: Paul E Peppard, Terry Young, Mari Palta, Jodi H Barnet, Erika W Hagen, Khin Mae HlaAbstract:Sleep-Disordered Breathing is a common disorder with a range of harmful sequelae. Obesity is a strong causal factor for sleep-Disordered Breathing, and because of the ongoing obesity epidemic, previous estimates of sleep-Disordered Breathing prevalence require updating. We estimated the prevalence of sleep-Disordered Breathing in the United States for the periods of 1988–1994 and 2007–2010 using data from the Wisconsin Sleep Cohort Study, an ongoing community-based study that was established in 1988 with participants randomly selected from an employed population of Wisconsin adults. A total of 1,520 participants who were 30–70 years of age had baseline polysomnography studies to assess the presence of sleep-Disordered Breathing. Participants were invited for repeat studies at 4-year intervals. The prevalence of sleep-Disordered Breathing was modeled as a function of age, sex, and body mass index, and estimates were extrapolated to US body mass index distributions estimated using data from the National Health and Nutrition Examination Survey. The current prevalence estimates of moderate to severe sleep-Disordered Breathing (apnea-hypopnea index, measured as events/hour, ≥15) are 10% (95% confidence interval (CI): 7, 12) among 30–49-year-old men; 17% (95% CI: 15, 21) among 50–70-year-old men; 3% (95% CI: 2, 4) among 30–49-year-old women; and 9% (95% CI: 7, 11) among 50–70 year-old women. These estimated prevalence rates represent substantial increases over the last 2 decades (relative increases of between 14% and 55% depending on the subgroup).
-
prospective study of the association between sleep Disordered Breathing and hypertension
The New England Journal of Medicine, 2000Co-Authors: Paul E Peppard, Terry Young, Mari Palta, James B. SkatrudAbstract:Background Sleep-Disordered Breathing is prevalent in the general population and has been linked to chronically elevated blood pressure in cross-sectional epidemiologic studies. We performed a prospective, population-based study of the association between objectively measured sleep-Disordered Breathing and hypertension (defined as a laboratory-measured blood pressure of at least 140/90 mm Hg or the use of antihypertensive medications). Methods We analyzed data on sleep-Disordered Breathing, blood pressure, habitus, and health history at base line and after four years of follow-up in 709 participants of the Wisconsin Sleep Cohort Study (and after eight years of follow-up in the case of 184 of these participants). Participants were assessed overnight by 18-channel polysomnography for sleep-Disordered Breathing, as defined by the apnea–hypopnea index (the number of episodes of apnea and hypopnea per hour of sleep). The odds ratios for the presence of hypertension at the four-year follow-up study according to...
-
population based study of sleep Disordered Breathing as a risk factor for hypertension
JAMA Internal Medicine, 1997Co-Authors: Terry Young, Mari Palta, Paul E Peppard, Laurel Finn, Mae K Hla, Barbara J Morgan, James B. SkatrudAbstract:Background: Clinical observations have linked sleepDisordered Breathing, a condition of repeated apneas and hypopneas during sleep, with hypertension but evidence for an independent association has been lacking. Understanding this relationship is important because the prevalence of sleep-Disordered Breathing is high in adults. Objective: To test the hypothesis that sleep-Disordered Breathing is related to elevated blood pressure independent of confounding factors. Methods: The sample included 1060 employed women and men aged 30 through 60 years who had completed an overnight protocol as part of the Wisconsin Sleep Cohort Study. In-laboratory polysomnography was used to determine sleep-Disordered Breathing status, quantified as the number of apneas and hypopneas per hour of sleep (apnea-hypopnea index). Blood pressure was measured on the night polysomnography was performed. Results: Blood pressure increased linearly with increasing apnea-hypopnea index (P=.003 for systolic,P=.01 for diastolic, adjusted for confounding factors). The magnitude of the linear association increased with decreasing obesity. At a body mass index (weight in kilograms divided by the square of the height in meters) of 30 kg/m2, an apnea-hypopnea index of 15 (vs 0) was associated with blood pressure increases of 3.6 mm Hg for systolic (95% confidence interval, 1.3-6.0) and 1.8 mm Hg for diastolic (95% confidence interval, 0.3-3.3). The odds ratio for hypertension associated with an apneahypopnea index of 15 (vs 0) was 1.8 (95% confidence interval, 1.3-2.4). Conclusions: There is a dose-response relationship between sleep-Disordered Breathing and blood pressure, independent of known confounding factors. If causal, the high prevalence of sleep-Disordered Breathing could account for hypertension in a substantial number of adults in the United States. Arch Intern Med. 1997;157:1746-1752
-
sleep Disordered Breathing and motor vehicle accidents in a population based sample of employed adults
Sleep, 1997Co-Authors: Terry Young, Laurel Finn, Joseph N Blustein, Mari PaltaAbstract:Studies have consistently shown that sleep apnea patients have high accident rates, but the generalizability of the association beyond clinic populations has been questioned. The goal of this investigation was to determine if unrecognized sleep-Disordered Breathing in the general population, ranging from mild to severe, is associated with motor vehicle accidents. The sample comprised 913 employed adults enrolled in an ongoing study of the natural history of sleep-Disordered Breathing. Sleep-Disordered Breathing status was determined by overnight in-laboratory polysomnography and motor vehicle accident (MVA) history was obtained from a statewide data base of all traffic violations and accidents from 1988 to 1993. Men with five or more apneas and hypopneas per hour of sleep [apnea-plus-hypopnea index (AHI) > 5], compared to those without sleep-Disordered Breathing, were significantly more likely to have at least one accident in 5 years (adjusted odds ratio = 3.4 for habitual snorers, 4.2 for AHI 5-15, and 3.4 for AHI > 15). Men and women combined with AHI > 15 (vs. no sleep-Disordered Breathing) were significantly more likely to have multiple accidents in 5 years (odds ratio = 7.3). These results, free of clinic selection bias, indicate that unrecognized sleep-Disordered Breathing in the general population is linked to motor vehicle accident occurrence. If the association is causal, unrecognized sleep-Disordered Breathing may account for a significant proportion of motor vehicle accidents. Language: en
-
sleep Disordered Breathing and motor vehicle accidents in a population based sample of employed adults
Sleep, 1997Co-Authors: Terry Young, Laurel Finn, Joseph N Blustein, Mari PaltaAbstract:Studies have consistently shown that sleep apnea patients have high accident rates, but the generalizability of the association beyond clinic populations has been questioned. The goal of this investigation was to determine if unrecognized sleep-Disordered Breathing in the general population, ranging from mild to severe, is associated with motor vehicle accidents. The sample comprised 913 employed adults enrolled in an ongoing study of the natural history of sleep-Disordered Breathing. Sleep-Disordered Breathing status was determined by overnight in-laboratory polysomnography and motor vehicle accident (MVA) history was obtained from a statewide data base of all traffic violations and accidents from 1988 to 1993. Men with five or more apneas and hypopneas per hour of sleep [apnea-plus-hypopnea index (AHI) > 5], compared to those without sleep-Disordered Breathing, were significantly more likely to have at least one accident in 5 years (adjusted odds ratio = 3.4 for habitual snorers, 4.2 for AHI 5-15, and 3.4 for AHI > 15). Men and women combined with AHI > 15 (vs. no sleep-Disordered Breathing) were significantly more likely to have multiple accidents in 5 years (odds ratio = 7.3). These results, free of clinic selection bias, indicate that unrecognized sleep-Disordered Breathing in the general population is linked to motor vehicle accident occurrence. If the association is causal, unrecognized sleep-Disordered Breathing may account for a significant proportion of motor vehicle accidents.
Laurel Finn - One of the best experts on this subject based on the ideXlab platform.
-
coronary heart disease incidence in sleep Disordered Breathing the wisconsin sleep cohort study
Sleep, 2015Co-Authors: Khin Mae Hla, Terry Young, Erika W Hagen, Laurel Finn, Javier F Nieto, James H Stein, Paul E PeppardAbstract:Study objectives The aim of the study was to determine the association of objectively measured sleep Disordered Breathing (SDB) with incident coronary heart disease (CHD) or heart failure (HF) in a nonclinical population. Design Longitudinal analysis of a community-dwelling cohort followed up to 24 y. Setting Sleep laboratory at the Clinical Research Unit of the University of Wisconsin Hospital and Clinics. Participants There were 1,131 adults who completed one or more overnight polysomnography studies, were free of CHD or HF at baseline, were not treated by continuous positive airway pressure (CPAP), and followed over 24 y. Interventions None. Measurements and results In-laboratory overnight polysomnography was used to assess SDB, defined by the apnea-hypopnea index (AHI) using apnea and hypopnea events per hour of sleep. Incident CHD or HF was defined by new reports of myocardial infarction, coronary revascularization procedures, congestive heart failure, and cardiovascular deaths. We used baseline AHI as the predictor variable in survival analysis models predicting CHD or HF incidence adjusted for traditional confounders. The incidence of CHD or HF was 10.9/1,000 person-years. The mean time to event was 11.2 ± 5.8 y. After adjusting for age, sex, body mass index, and smoking, estimated hazard ratios (95% confidence interval) of incident CHD or HF were 1.5 (0.9-2.6) for AHI > 0-5, 1.9 (1.05-3.5) for AHI 5 ≤ 15, 1.8 (0.85-4.0) for AHI 15 ≤ 30, and 2.6 (1.1-6.1) for AHI > 30 compared to AHI = 0 (P trend = 0.02). Conclusions Participants with untreated severe sleep Disordered Breathing (AHI > 30) were 2.6 times more likely to have an incident coronary heart disease or heart failure compared to those without sleep Disordered Breathing. Our findings support the postulated adverse effects of sleep Disordered Breathing on coronary heart disease and heart failure.
-
association of sleep Disordered Breathing and the occurrence of stroke
American Journal of Respiratory and Critical Care Medicine, 2005Co-Authors: Michael Arzt, Terry Young, Laurel Finn, James B. Skatrud, Douglas T BradleyAbstract:Rationale: Sleep-Disordered Breathing has been linked to stroke in previous studies. However, these studies either used surrogate markers of sleep-Disordered Breathing or could not, due to cross-sectional design, address the temporal relationship between sleep-Disordered Breathing and stroke. Objectives: To determine whether sleep-Disordered Breathing increases the risk for stroke. Methods: We performed cross-sectional and longitudinal analyses on 1,475 and 1,189 subjects, respectively, from the general population. Sleep-Disordered Breathing was defined by the apnea–hypopnea index (frequency of apneas and hypopneas per hour of sleep) obtained by attended polysomnography. The protocol, including polysomnography, risk factors for stroke, and a history of physician-diagnosed stroke, was repeated at 4-yr intervals. Measurements and Main Results: In the cross-sectional analysis, subjects with an apnea–hypopnea index of 20 or greater had increased odds for stroke (odds ratio, 4.33; 95% confidence interval, 1.32–14.24; p = 0.02) compared with those without sleep-Disordered Breathing (apnea–hypopnea index, <5) after adjustment for known confounding factors. In the prospective analysis, sleep-Disordered Breathing with an apnea–hypopnea index of 20 or greater was associated with an increased risk of suffering a first-ever stroke over the next 4 yr (unadjusted odds ratio, 4.31; 95% confidence interval, 1.31–14.15; p = 0.02). However, after adjustment for age, sex, and body mass index, the odds ratio was still elevated, but was no longer significant (3.08; 95% confidence interval, 0.74–12.81; p = 0.12). Conclusions: These data demonstrate a strong association between moderate to severe sleep-Disordered Breathing and prevalent stroke, independent of confounding factors. They also provide the first prospective evidence that sleep-Disordered Breathing precedes stroke and may contribute to the development of stroke.
-
menopausal status and sleep Disordered Breathing in the wisconsin sleep cohort study
American Journal of Respiratory and Critical Care Medicine, 2003Co-Authors: Terry Young, Laurel Finn, Diane Austin, Andrea PetersonAbstract:Menopause is considered to be a risk factor for sleep-Disordered Breathing, but this hypothesis has not been adequately tested. The association of premenopause, perimenopause, and postmenopause with sleep-Disordered Breathing was investigated with a population-based sample of 589 women enrolled in the Wisconsin Sleep Cohort Study. Menopausal status was determined from menstrual history, gynecologic surgery, hormone replacement therapy, follicle-stimulating hormone, and vasomotor symptoms. Sleep-Disordered Breathing was indicated by the frequency of apnea and hypopnea events per hour of sleep, measured by in-laboratory polysomnography. Multivariable logistic regression was used to estimate odds ratios for having 5 or more and 15 or more apnea and hypopnea events per hour. Odds ratios (95% confidence interval), adjusted for age, body habitus, smoking, and other potential confounding factors, for 5 or more apnea and hypopnea events per hour were 1.2 (0.7, 2.2) with perimenopause and 2.6 (1.4, 4.8) with postm...
-
population based study of sleep Disordered Breathing as a risk factor for hypertension
JAMA Internal Medicine, 1997Co-Authors: Terry Young, Mari Palta, Paul E Peppard, Laurel Finn, Mae K Hla, Barbara J Morgan, James B. SkatrudAbstract:Background: Clinical observations have linked sleepDisordered Breathing, a condition of repeated apneas and hypopneas during sleep, with hypertension but evidence for an independent association has been lacking. Understanding this relationship is important because the prevalence of sleep-Disordered Breathing is high in adults. Objective: To test the hypothesis that sleep-Disordered Breathing is related to elevated blood pressure independent of confounding factors. Methods: The sample included 1060 employed women and men aged 30 through 60 years who had completed an overnight protocol as part of the Wisconsin Sleep Cohort Study. In-laboratory polysomnography was used to determine sleep-Disordered Breathing status, quantified as the number of apneas and hypopneas per hour of sleep (apnea-hypopnea index). Blood pressure was measured on the night polysomnography was performed. Results: Blood pressure increased linearly with increasing apnea-hypopnea index (P=.003 for systolic,P=.01 for diastolic, adjusted for confounding factors). The magnitude of the linear association increased with decreasing obesity. At a body mass index (weight in kilograms divided by the square of the height in meters) of 30 kg/m2, an apnea-hypopnea index of 15 (vs 0) was associated with blood pressure increases of 3.6 mm Hg for systolic (95% confidence interval, 1.3-6.0) and 1.8 mm Hg for diastolic (95% confidence interval, 0.3-3.3). The odds ratio for hypertension associated with an apneahypopnea index of 15 (vs 0) was 1.8 (95% confidence interval, 1.3-2.4). Conclusions: There is a dose-response relationship between sleep-Disordered Breathing and blood pressure, independent of known confounding factors. If causal, the high prevalence of sleep-Disordered Breathing could account for hypertension in a substantial number of adults in the United States. Arch Intern Med. 1997;157:1746-1752
-
sleep Disordered Breathing and motor vehicle accidents in a population based sample of employed adults
Sleep, 1997Co-Authors: Terry Young, Laurel Finn, Joseph N Blustein, Mari PaltaAbstract:Studies have consistently shown that sleep apnea patients have high accident rates, but the generalizability of the association beyond clinic populations has been questioned. The goal of this investigation was to determine if unrecognized sleep-Disordered Breathing in the general population, ranging from mild to severe, is associated with motor vehicle accidents. The sample comprised 913 employed adults enrolled in an ongoing study of the natural history of sleep-Disordered Breathing. Sleep-Disordered Breathing status was determined by overnight in-laboratory polysomnography and motor vehicle accident (MVA) history was obtained from a statewide data base of all traffic violations and accidents from 1988 to 1993. Men with five or more apneas and hypopneas per hour of sleep [apnea-plus-hypopnea index (AHI) > 5], compared to those without sleep-Disordered Breathing, were significantly more likely to have at least one accident in 5 years (adjusted odds ratio = 3.4 for habitual snorers, 4.2 for AHI 5-15, and 3.4 for AHI > 15). Men and women combined with AHI > 15 (vs. no sleep-Disordered Breathing) were significantly more likely to have multiple accidents in 5 years (odds ratio = 7.3). These results, free of clinic selection bias, indicate that unrecognized sleep-Disordered Breathing in the general population is linked to motor vehicle accident occurrence. If the association is causal, unrecognized sleep-Disordered Breathing may account for a significant proportion of motor vehicle accidents. Language: en
Paul E Peppard - One of the best experts on this subject based on the ideXlab platform.
-
coronary heart disease incidence in sleep Disordered Breathing the wisconsin sleep cohort study
Sleep, 2015Co-Authors: Khin Mae Hla, Terry Young, Erika W Hagen, Laurel Finn, Javier F Nieto, James H Stein, Paul E PeppardAbstract:Study objectives The aim of the study was to determine the association of objectively measured sleep Disordered Breathing (SDB) with incident coronary heart disease (CHD) or heart failure (HF) in a nonclinical population. Design Longitudinal analysis of a community-dwelling cohort followed up to 24 y. Setting Sleep laboratory at the Clinical Research Unit of the University of Wisconsin Hospital and Clinics. Participants There were 1,131 adults who completed one or more overnight polysomnography studies, were free of CHD or HF at baseline, were not treated by continuous positive airway pressure (CPAP), and followed over 24 y. Interventions None. Measurements and results In-laboratory overnight polysomnography was used to assess SDB, defined by the apnea-hypopnea index (AHI) using apnea and hypopnea events per hour of sleep. Incident CHD or HF was defined by new reports of myocardial infarction, coronary revascularization procedures, congestive heart failure, and cardiovascular deaths. We used baseline AHI as the predictor variable in survival analysis models predicting CHD or HF incidence adjusted for traditional confounders. The incidence of CHD or HF was 10.9/1,000 person-years. The mean time to event was 11.2 ± 5.8 y. After adjusting for age, sex, body mass index, and smoking, estimated hazard ratios (95% confidence interval) of incident CHD or HF were 1.5 (0.9-2.6) for AHI > 0-5, 1.9 (1.05-3.5) for AHI 5 ≤ 15, 1.8 (0.85-4.0) for AHI 15 ≤ 30, and 2.6 (1.1-6.1) for AHI > 30 compared to AHI = 0 (P trend = 0.02). Conclusions Participants with untreated severe sleep Disordered Breathing (AHI > 30) were 2.6 times more likely to have an incident coronary heart disease or heart failure compared to those without sleep Disordered Breathing. Our findings support the postulated adverse effects of sleep Disordered Breathing on coronary heart disease and heart failure.
-
increased prevalence of sleep Disordered Breathing in adults
American Journal of Epidemiology, 2013Co-Authors: Paul E Peppard, Terry Young, Mari Palta, Jodi H Barnet, Erika W Hagen, Khin Mae HlaAbstract:Sleep-Disordered Breathing is a common disorder with a range of harmful sequelae. Obesity is a strong causal factor for sleep-Disordered Breathing, and because of the ongoing obesity epidemic, previous estimates of sleep-Disordered Breathing prevalence require updating. We estimated the prevalence of sleep-Disordered Breathing in the United States for the periods of 1988–1994 and 2007–2010 using data from the Wisconsin Sleep Cohort Study, an ongoing community-based study that was established in 1988 with participants randomly selected from an employed population of Wisconsin adults. A total of 1,520 participants who were 30–70 years of age had baseline polysomnography studies to assess the presence of sleep-Disordered Breathing. Participants were invited for repeat studies at 4-year intervals. The prevalence of sleep-Disordered Breathing was modeled as a function of age, sex, and body mass index, and estimates were extrapolated to US body mass index distributions estimated using data from the National Health and Nutrition Examination Survey. The current prevalence estimates of moderate to severe sleep-Disordered Breathing (apnea-hypopnea index, measured as events/hour, ≥15) are 10% (95% confidence interval (CI): 7, 12) among 30–49-year-old men; 17% (95% CI: 15, 21) among 50–70-year-old men; 3% (95% CI: 2, 4) among 30–49-year-old women; and 9% (95% CI: 7, 11) among 50–70 year-old women. These estimated prevalence rates represent substantial increases over the last 2 decades (relative increases of between 14% and 55% depending on the subgroup).
-
Exercise Is Associated with a Reduced Incidence of Sleep-Disordered Breathing
The American Journal of Medicine, 2012Co-Authors: Karim M. Awad, Stuart F. Quan, Jodi H Barnet, Atul Malhotra, Paul E PeppardAbstract:Background The effect of exercise on sleep-Disordered Breathing is unknown. While diet and weight loss have been shown to reduce the severity of sleep-Disordered Breathing, it is unclear whether exercise has an independent effect.
-
the impact of obesity on oxygen desaturation during sleep Disordered Breathing
American Journal of Respiratory and Critical Care Medicine, 2009Co-Authors: Paul E Peppard, Neil R Ward, Mary J MorrellAbstract:Rationale: Obesity increases the risk and severity of sleep-Disordered Breathing. The degree to which excess body weight contributes to blood oxygen desaturation during hypopneic and apneic events has not been comprehensively characterized.Objectives: To quantify the association between excess body weight and oxygen desaturation during sleep-Disordered Breathing.Methods: A total of 750 adult participants in the Wisconsin Sleep Cohort Study were assessed for body mass index (BMI) (kg/m2) and sleep-Disordered Breathing. The amount of SaO2, duration, and other characteristics of 37,473 observed Breathing events were measured during polysomnography studies. A mixed-effects linear regression model estimated the association of blood oxygen desaturation with participant-level characteristics, including BMI, gender, and age, and event-level characteristics, including baseline SaO2, change in Vt, event duration, sleep state, and body position.Measurements and Main Results: BMI was positively associated with oxygen...
-
excess weight and sleep Disordered Breathing
Journal of Applied Physiology, 2005Co-Authors: Terry Young, Paul E Peppard, Shahrad TaheriAbstract:Excess weight is a well-established predictor of sleep-Disordered Breathing (SDB). Clinical observations and population studies throughout the United States, Europe, Asia, and Australia have consis...