Sleep apnea, coronary artery calcium density, and cardiovascular events: Results from the Multi-Ethnic Study of Atherosclerosis

Seth B. Newman, Vaishnavi Kundel, Mika Matsuzaki, Michelle Reid, Jorge R. Kizer, Robert C. Kaplan, Zahi A. Fayad, Venkatesh Mani, Steven Shea, Matthew Allison, Michael H. Criqui, Pamela L. Lutsey, Robyn L. McClelland, Susan Redline, Neomi A. Shah

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Study Objectives: Evaluate the association between obstructive sleep apnea (OSA), coronary artery calcium (CAC) density, and cardiovascular events in the Multi- Ethnic Study of Atherosclerosis (MESA). Methods:We analyzed 1,041 participants with nonzero CAC scores who had polysomnography and CAC density data from the fifth examination of the Multi-Ethnic Study of Atherosclerosis. OSA was defined as apnea-hypopnea index ≥ 15 events/h. Multivariable linear regression models were used to evaluate the independent associationbetweenOSAandCACdensity. Additionally,weevaluatedtheimpact ofOSAonassociations ofCACmeasureswith incident cardiovasculardisease events by testing for interaction in Cox proportional hazard regression models. Results: Our analytical sample was 45% female with a mean age of 70.6 +/29 years. Of this sample, 36.7% (n = 383/1041) had OSA (apnea-hypopnea index ≥ 15 events/h). OSA was inversely and weakly associated with CAC density (b = -0.09; 95% CI, -0.17 to -0.02; P = .014) and remained significantly associated after controlling for traditional cardiovascular risk factors (b= -0.08;95%CI, -0.16 to 0;P= .043). However, this inverse association was attenuated after controlling for body massindex (b= -0.05;95%CI, -0.13 to 0.02;P= .174). Themeanfollow-up period for cardiovascular disease events was 13.3 +/22.8 years. Additionally, exploratory analysis demonstrated that CAC density was independently and inversely associated with cardiovascular disease events only in the non-OSA subgroup (apneahypopnea index ≤ 15 events/h) (hazard ratio, 0.509; 95% CI, 0.323-0.801); P = .0035). Conclusions: OSAwas associated with lower CAC density, but this association was attenuated by body mass index. Further, increased CAC density was associated with a reduced risk of cardiovascular disease events only in individuals within the non-OSA group in exploratory analysis.

Original languageEnglish (US)
Pages (from-to)2075-2083
Number of pages9
JournalJournal of Clinical Sleep Medicine
Issue number10
StatePublished - Oct 1 2021


  • Atherosclerosis
  • Coronary artery calcium
  • Sleep apnea

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology


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