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Interactions between Obstructive Sleep Apnea and Sleep Duration with Subclinical Atherosclerosis Evaluated by Coronary Calcium Score: Cross-sectional Data from ELSA-Brasil study.


Recent data suggest that sleep disorders like Obstructive Sleep Apnea (OSA) and extremes of Sleep Duration (SD) are associated with coronary artery disease. However, the interaction of OSA and SD with subclinical markers of the coronary atherosclerosis remains to be determined.


To Test the association of OSA, SD and their interactions on subclinical atherosclerosis evaluated by cornary artery calcium ( CAC) score.


We consecutively evaluated participants from ELSA-Brasil, a cohort study of adult civil servants. All participants were submitted to a single night portable sleep monitoring (Embletta GoldTM) to determine OSA status and wrist actigraphy during one week (Actiwatch 2TM) for the objective ascertainment of the SD. An apnea-hypopnea index (AHI) <5 events per hour was considered normal; AHI 5-14.9 and IAH ≥15 events/hour were classified as mild OSA and moderate-severe OSA, respectively. Computed tomography using a Philips Brilliance 64-detectot scanner (Philips Healthcare, Andover, MA) was performed to assess the calcium score by a standard protocol adjusted for each participant’s biotype. Subclinical atherosclerosis was defined as a CAC >100 score. Analysis of adjustment for potential confounding factors was performed, including age, sex, and cardiovascular risk factors and drug use.


We studied 2,169 participants (age: 49±8 years; 56.6% female). The frequency for OSA was 32%. We observed a progressive increase in the frequency of CAC >100 in parallel to the severity of OSA: No OSA: 4%, mild OSA: 8% and moderate-severe OSA: 12% (p trend: <0.001). Interestingly, participants with long SD (>8 hours) presented higher frequency of CAC >100 (15%) as compared to subject with SD 6-8 hours (7%) and SD <6 hours (9%; p trend: 0.01). In the logistic regression, moderate-severe OSA (OR 1.18; IC 95%: 0,85 1,64) or SD >8 hours (OR 1.39; IC 95%: 0,88 2,21) were not associated with CAC >100. However, the interaction of OSA with SD >8 hours was independently associated with CAC >100 (OR 2.78; p=0.01) when compared to the reference group (no OSA, SD <8 hours).


We observed an interesting interaction of OSA with long SD (>8 hours) with almost three-fold chance to present relevant subclinical atherosclerosis (defined by a CAC >100).


Obstructive Sleep Apnea , Sleep Duration, coronary artery disease, coronary atherosclerosis.


Área Clínica


Silvana Pereira Souza, Márcio Sommer BIttencourt, Ronaldo Batista Santos, Bárbara Khonangz Parise, Soraya Giatti, Aline Nogueira Aielo, Wagner Alves Silva, Isabela M. Bensenor, Paulo Andrade Lotufo, Luciano Ferreira Drager