Incident coronary calcium score in patients with obstructive sleep apnea with and without excessive sleepiness: the ELSA-Brasil study

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dc.contributorCentro de Ensaios Clínicos e Farmacovigilânciapt_BR
dc.contributor.authorde Miranda, Erique Jose Farias Peixotopt_BR
dc.contributor.authorMazzotti, Diego R.pt_BR
dc.contributor.authorSantos , Ronaldo B.pt_BR
dc.identifier.citationde Miranda EJFP. Incident coronary calcium score in patients with obstructive sleep apnea with and without excessive sleepiness: the ELSA-Brasil study. Chest. 2023 Jun; in press. doi:10.1016/j.chest.2023.06.025.pt_BR
dc.description.abstractBackground There is uncertainty about the impact of obstructive sleep apnea (OSA) and its phenotypes on cardiovascular disease. Research Question Are OSA and clinical features such as daytime sleepiness associated with incident subclinical coronary atherosclerosis? Study Design and Methods In this prospective community-based cohort study, we performed a sleepiness questionnaire, actigraphy, and home sleep studies at baseline. Coronary artery calcium, 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 of subclinical atherosclerosis was defined as baseline CAC=0 followed by CAC>0 at a 5-year follow-up visit. The association of incident CAC outcome was assessed using logistic regression. Stratified analyses based on excessive daytime sleepiness (EDS) were performed. Results We analyzed 1,956 participants with available CAC scores at baseline (age: 49±8 years; 57.9% women; 32.4% with OSA). In covariate-adjusted analyses (n=1,247, mean follow-up=5.1±0.9 years), we found a significant association between OSA and incidence of subclinical atherosclerosis (OR=1.26; 95% CI 1.06–1.48), with stronger effects among those reporting EDS (OR=1.66; 95% CI: 1.30–2.12; p for interaction=0.028). Interestingly, EDS per se was not associated with any CAC outcome. An exploratory analysis of CAC progression (baseline CAC>0 followed by a numerical increase in scores at follow-up) (n=319) showed a positive association for both OSA (β=1.084; 95% CI: 0.032 to 2.136; p=0.043) and OSA with EDS (β=1.651; 95% CI: 0.208 to 3.094; p=0.025). Interpretation OSA, particularly with EDS, predicts the incidence and progression of CAC. These results support biological plausibility for the increased cardiovascular risk observed among patients with OSA with excessive sleepiness.pt_BR
dc.description.sponsorship(FAPESP) Fundação de Amparo à Pesquisa do Estado de São Paulopt_BR
dc.description.sponsorship(AHA) American Heart Associationpt_BR
dc.rightsRestricted accesspt_BR
dc.titleIncident coronary calcium score in patients with obstructive sleep apnea with and without excessive sleepiness: the ELSA-Brasil studypt_BR
dc.contributor.externalUniversity of Kansas Medical Centerpt_BR
dc.contributor.external(USP) Universidade de São Paulopt_BR
dc.contributor.externalUniversity of Pittsburghpt_BR
dc.subject.keywordcardiovascular diseasept_BR
dc.subject.keywordobstructive sleep apneapt_BR
dc.subject.keywordexcessive daytime sleepinesspt_BR
dc.identifier.citationabntin press, jun. 2023pt_BR
dc.identifier.citationvancouver2023 Jun; in presspt_BR
dc.contributor.butantande Miranda, Erique Jose Farias Peixoto|:Outros|:Centro de Ensaios Clínicos e Farmacovigilância|:pt_BR
dc.sponsorship.butantan(FAPESP) Fundação de Amparo à Pesquisa do Estado de São Paulo¦¦2019/23496-8pt_BR
dc.sponsorship.butantan(AHA) American Heart Association¦¦20CDA35310360pt_BR
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