The interaction between obstructive sleep apnea (OSA) and long sleep duration (>8 hours) was associated with a nearly 3-fold chance of having  a coronary artery calcium (CAC) score of >100, according to analysis results presented at the 2019 Annual Meeting of the World Sleep Society, held September 20-25 in Vancouver, Canada.

Recognizing that recent data suggest that sleep disorders can contribute to the progression of coronary artery disease, investigators sought to explore the interaction of OSA and sleep duration with subclinical markers of coronary atherosclerosis. Consecutive patients from the ELSA Brasil cohort underwent a single night portable sleep monitoring test to determine their OSA status and wrist actigraphy during the course of 1 week for the objective ascertainment of their sleep duration. An apnea-hypopnea index (AHI) of <5 events per hour was considered normal, an AHI of 5 to 14.9 events per hour was deemed mild OSA, and an AHI of ≥15 events per hour was classified as moderate to severe OSA.

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Computed tomography was conducted to evaluate an individual’s CAC score using a standard protocol that was adjusted for each participant’s biotype. The presence of subclinical coronary atherosclerosis was defined as a CAC score of >100. Adjustment was performed for potential confounding factors, including age, sex, cardiovascular risk factors, and medication use.

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A total of 2169 patients were evaluated. The mean patient age was 49±8 years; 56.6% of the individuals were women. Study results showed the frequency of OSA to be 32% among all patients. A progressive increase in the frequency of a CAC score of >100 was observed relative to the severity of OSA, which translated to the following: no OSA: 4%, mild OSA: 8%, and moderate to severe OSA: 12% (P<.001).

Patients with a long sleep duration (ie, >8 hours) had a higher frequency of a CAC score >100 (15%) compared with patients with a sleep duration between 6 and 8 hours (7%) and patients with a sleep duration of <6 hours (9%; P =.01).

Logistic regression demonstrated that neither the presence of moderate to severe OSA (odds ratio [OR], 1.18; 95% CI, 0.85-1.64) nor a sleep duration of >8 hours (OR, 1.39; 95% CI, 0.88-2.21) was associated with a CAC score of >100. The interaction between OSA and a sleep duration of >8 hours, however, was independently and significantly associated with a CAC score of >100 (OR, 2.78; P =.01) compared with the reference group (no OSA; sleep duration <8 hours).

The investigators concluded that the presence of OSA and long sleep duration was linked to a nearly 3-fold chance of having a CAC score of >100.


Pereira e Souza S, Bittencourt MS, Parise BK, et al. Interactions between obstructive sleep apnea and sleep duration with subclinical atherosclerosis evaluated by coronary calcium score: cross-sectional data from ELSA-Brasil study. Presented at: World Sleep Society 2019 Annual Meeting; September 20-25, 2019; Vancouver, Canada. Abstract 311.

This article originally appeared on Pulmonology Advisor