Dados do Trabalho

Título

Incident and Progression of Coronary Calcium Score in Patients with Obstructive Sleep Apnea: the ELSA-Brasil study.

Introdução

Recent evidence suggests that symptomatic obstructive sleep apnea (OSA) phenotypes are particularly susceptible to cardiovascular events. The development of atherosclerosis is a plausible mechanism but the impact of OSA on atherosclerosis is unclear.

Objetivo

To assess the role of OSA and related clinical features on incidence and progression of coronary artery calcium (CAC) scores.

Métodos

In the ELSA-Brasil, a prospective community-based cohort study, we performed a sleepiness questionnaire, actigraphy, and home sleep studies at baseline. CAC (64-slice multi-detector computed tomography) was measured at two different time points throughout the study (baseline, between 2010-2014, and follow-up, between 2016-2018). Incidence and progression of subclinical atherosclerosis (defined as baseline CAC=0 followed by CAC>0 at a 5-year follow-up visit; baseline CAC>0 followed by a numerical increase in scores at follow-up, respectively). The association of these two CAC outcomes was assessed using logistic regression. Stratified analyses based on excessive daytime sleepiness (EDS) were performed.

Resultados

We analyzed 1,956 participants with available CAC scores at baseline (age: 49±8 years; 57.9% women; 28.2% with OSA). We found a higher prevalence of CAC>0 in OSA patients (31.3%) compared to those without OSA (19.0%; p<0.001). In adjusted models, we did not find a significant association between OSA and prevalent CAC (OR=0.92; 95% CI:0.67–1.27;p=0.607). However, in longitudinal analyses (n=1,247, mean follow-up=5.1±0.9 years), we found a significant association between OSA and incidence of subclinical atherosclerosis among those reporting EDS after adjusting for covariates (OR=1.90; 95% CI:1.02–3.51;p=0.042). Furthermore, analysis of CAC progression (n=319) showed a positive association for both OSA (Beta=1.084; 95% CI:0.032-2.136;p=0.043) and OSA with EDS (Beta=1.651; 95% CI:0.208–3.094;p=0.025).

Conclusões

OSA, particularly with EDS, predicts the incidence and progression of CAC. These results provided biological plausibility for the higher cardiovascular risk observed in excessively sleepy patients.

Palavras -chave

atherosclerosis; cardiovascular disease; obstructive sleep apnea; excessive daytime sleepiness.