Sleep disordered breathing and risk of stroke in older community-dwelling men

Katie L. Stone, Terri L. Blackwell, Sonia Ancoli-Israel, Elizabeth Barrett-Connor, Douglas C. Bauer, Jane A. Cauley, Kristine E. Ensrud, Andrew R. Hoffman, Reena Mehra, Marcia L. Stefanick, Paul D. Varosy, Kristine Yaffe, Susan Redline

Research output: Contribution to journalArticlepeer-review

39 Scopus citations

Abstract

Study Objectives: Men with sleep disordered breathing (SDB) may be at increased stroke risk, due to nocturnal hypoxemia, sleep loss or fragmentation, or other mechanisms. We examined the association of SDB with risk of incident stroke in a large cohort of older men. Methods: Participants were 2,872 community-dwelling men (mean age 76 years) enrolled in the MrOS Sleep Study, which gathered data from 2003 to 2005 at six clinical sites in the Unites States. SDB predictors (obstructive apnea-hypopnea index, apnea-hypopnea index, central apnea index, and nocturnal hypoxemia) were measured using overnight polysomnography. Incident stroke over an average follow-up of 7.3 years was centrally adjudicated by physician review of medical records. Results: One hundred fifty-six men (5.4%) had a stroke during follow-up. After adjustment for age, clinic site, race, body mass index, and smoking status, older men with severe nocturnal hypoxemia (≥ 10% of the night with SpO2 levels below 90%) had a 1.8-fold increased risk of incident stroke compared to those without nocturnal hypoxemia (relative hazard = 1.83; 95% confidence interval 1.12-2.98; P trend = 0.02). Results were similar after further adjustment for other potential covariates and after excluding men with a history of stroke. Other indices of SDB were not associated with incident stroke. Conclusions: Older men with severe nocturnal hypoxemia are at significantly increased risk of incident stroke. Measures of overnight oxygen saturation may better identify older men at risk for stroke than measures of apnea frequency.

Original languageEnglish (US)
Pages (from-to)531-540
Number of pages10
JournalSleep
Volume39
Issue number3
DOIs
StatePublished - Mar 1 2016

Bibliographical note

Funding Information:
This was not an industry supported study. The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. The National Heart, Lung, and Blood Institute (NHLBI) provides funding for the MrOS Sleep ancillary study ?Outcomes of Sleep Disorders in Older Men? under the following grant numbers: R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. Dr Yaffe received funding from K 24 grant AG031155. The measurement of inflammation markers was funded by the NHLBI, grant number R01 HL089467. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or the decision to submit the manuscript for publication. Dr. Stone has consulted for Merck. Dr. Ancoli-Israel is a consultant for Merck and Purdue University. Dr. Redline?s institution has received grant funding from ResMed, Inc, Philips Respironics, and ResMed Foundation and equipment from them for use in NIH studies. The other authors have indicated no financial conflicts of interest. Analysis was performed at California Pacific Medical Center, Research Institute.

Funding Information:
This was not an industry supported study. The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. The National Heart, Lung, and Blood Institute (NHLBI) provides funding for the MrOS Sleep ancillary study “Outcomes of Sleep Disorders in Older Men” under the following grant numbers: R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. Dr Yaffe received funding from K 24 grant AG031155. The measurement of inflammation markers was funded by the NHLBI, grant number R01 HL089467. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or the decision to submit the manuscript for publication. Dr. Stone has consulted for Merck. Dr. Ancoli-Israel is a consultant for Merck and Purdue University. Dr. Redline’s institution has received grant funding from ResMed, Inc, Philips Respironics, and ResMed Foundation and equipment from them for use in NIH studies. The other authors have indicated no financial conflicts of interest. Analysis was performed at California Pacific Medical Center, Research Institute.

Keywords

  • Nocturnal hypoxemia
  • Sleep disordered breathing
  • Stroke

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