ADVERTISEMENT

Issue Navigator

Volume 14 No. 11
Earn CME
Accepted Papers
Classifieds





Scientific Investigations

Risk of Cardiovascular Disease Related to Smoking Is Greater Among Women With Sleep-Disordered Breathing

Lucas M. Donovan, MD, MS1,2; Laura C. Feemster, MD, MS1,2; Martha E. Billings, MD, MS2; Laura J. Spece, MD, MS1,2; Matthew F. Griffith, MD1,2; Peter J. Rise, MS1; Elizabeth C. Parsons, MD, MS1,2; Brian N. Palen, MD1,2; Daniel J. O'Hearn, MD1,2; Susan Redline, MD, MPH3; David H. Au, MD, MS1,2; Vishesh K. Kapur, MD, MPH2
1Veterans Affairs Puget Sound Healthcare System, Seattle, Washington; 2Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington; 3Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts

Study Objectives:

Although both sleep-disordered breathing (SDB) and smoking are associated with cardiovascular disease (CVD), the potential for an interactive effect on CVD risk has not been explored. Our objective was to determine if smoking-related risk for CVD rises with greater SDB severity.

Methods:

Polysomnography and smoking history were obtained in 3,852 men and women in the Sleep Heart Health Study without baseline CVD. Fine-Gray proportional hazard models accounting for competing risk were used to calculate risk of incident CVD associated with SDB severity (defined by clinical cutoffs of the apnea-hypopnea index), smoking status (never, former, and current) and their interaction adjusting for potential confounders.

Results:

Over a mean (standard deviation) follow-up period of 10.3 (3.4) years, there were 694 incident CVD events. We found a significant three-way interaction of sex, current smoking, and moderate to severe SDB (P = .039) in the adjusted proportional hazards model. In adjusted analyses, women who were current smokers with moderate to severe SDB had a hazard ratio for incident CVD of 3.5 (95% confidence interval 1.6–8.0) relative to women who were nonsmokers without SDB. No such difference in CVD risk was observed in men or women of other strata of smoking and SDB.

Conclusions:

In women, smoking-related risk for CVD is significantly higher among individuals with moderate to severe SDB.

Citation:

Donovan LM, Feemster LC, Billings ME, Spece LJ, Griffith MF, Rise PJ, Parsons EC, Palen BN, O'Hearn D, Redline S, Au DH, Kapur VK. Risk of cardiovascular disease related to smoking is greater among women with sleep-disordered breathing. J Clin Sleep Med. 2018;14(11):1929–1935.


Supplemental Material

Login to view supplemental material



Please login to continue reading the full article

Subscribers to JCSM get full access to current and past issues of the JCSM.

Login to JCSM

Not a subscriber?

Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership

Subscribe to JCSM:  $75/volume year for individuals or $140/volume year for institutions to access all current articles and archives published in JCSM.

Download this article*:   $20 to access a PDF version of a specific article from the current issue of JCSM.

*Purchase of an electronic download of JCSM provides permission to access and print the issue/article for personal scholarly, research and educational use. Please note: access to the article is from the computer on which the article is purchased ONLY. Purchase of the article does not permit distribution, electronic or otherwise, of the article without the written permission of the AASM. Further, purchase does not permit the posting of article text on an online forum or website.