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Influence of lung function and sleep-disordered breathing on stroke: a community-based study.

ABSTRACT: BACKGROUND AND PURPOSE:Impaired lung function is regarded as a risk factor for stroke in patients with chronic obstructive pulmonary disease. However, the association between reduced lung function and incident stroke in a community-based population with sleep-disordered breathing (SDB) remains unknown. METHODS:A prospective study was performed within the Sleep Heart Health Study cohort. Full montage home sleep testing and spirometry data on 2082 and 2072 individuals with and without SDB, respectively, were analysed. Cox proportional hazards regression models were used to estimate the association between lung function and incident stroke. RESULTS:Over 11.7 years, 183 cases of stroke were identified in participants without pre-existing cardiovascular diseases, including 71 and 112 with an apnoea-hypopnoea index <5 events/h and ?5 events/h, respectively. In the entire population, lung function was inversely associated with incident stroke [hazard ratio (HR) 0.913 (95% confidence interval 0.839-0.994) for every 10% increase in percentage of predicted forced vital capacity]. When the population was divided according to the presence/absence of SDB, the association of lung function with incident stroke became stronger in individuals with SDB [HR 0.899 (0.822-0.984) for every 10% increase in percentage of predicted forced expiratory volume in 1 s; HR 0.881 (0.787-0.987) for every 10% increase in percentage of predicted forced vital capacity] but not in individuals without SDB. CONCLUSIONS:Lung function may serve as a risk factor for incident stroke in a community-based population, especially in those with SDB. Spirometry may help improve the risk management for primary care in community-based populations.

SUBMITTER: Zhang J

PROVIDER: S-EPMC6181793 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Influence of lung function and sleep-disordered breathing on stroke: a community-based study.

Zhang J J Gong Z Z Li R R Gao Y Y Li Y Y Li J J Yan B B Wang G G

European journal of neurology 20180718 11

<h4>Background and purpose</h4>Impaired lung function is regarded as a risk factor for stroke in patients with chronic obstructive pulmonary disease. However, the association between reduced lung function and incident stroke in a community-based population with sleep-disordered breathing (SDB) remains unknown.<h4>Methods</h4>A prospective study was performed within the Sleep Heart Health Study cohort. Full montage home sleep testing and spirometry data on 2082 and 2072 individuals with and witho ...[more]

PMID: 29924443

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Project description:Study objectivesSleep disordered breathing is associated with cardiovascular disease. The pathophysiologic mechanisms remain unclear, but enhanced vascular inflammation is implicated. We sought to evaluate the association of sleep disordered breathing with biomarkers of inflammation.DesignCross-sectional, observational.SettingCommunity-based.ParticipantsThere were 900 participants from the Framingham Heart Study site of the Sleep Heart Health Study (52% females, mean age 60 y, 23% ethnic minorities).InterventionsNone.MeasurementsWe assessed circulating levels of nine inflammatory biomarkers in relation to polysomnographically-derived apnea-hypopnea index and hypoxemia index (% sleep time with oxyhemoglobin saturation < 90%). Multivariable models were adjusted for demographics, smoking, cardiovascular diseases, diabetes, and other potential confounders, without and with adjustment for body mass index.ResultsWith multivariable adjustment not including body mass index, the apnea-hypopnea index was associated with C-reactive protein, inter-leukin-6, fibrinogen, intercellular adhesion molecule-1, and P-selectin levels and hypoxemia index was associated with C-reactive protein, interleukin-6, and fibrinogen levels. After adjustment for body mass index, only the association of interleukin-6 with sleep disordered breathing remained significant: the adjusted mean serum interleukin-6 level was 2.93, 3.14, 3.34, and 4.62 pg/mL, respectively, in participants with apnea-hypopnea index < 5, 5-14.9, 15-29.9, and ? 30 events/h (P = 0.01 for trend) and 2.97, 3.01, 3.35, and 4.85 pg/mL, respectively, in participants with hypoxemia index < 0.5, 0.5-4.9, 5-9.9, and ? 10% of sleep time (P = 0.02 for trend).ConclusionsIn a community-based sample, sleep disordered breathing is associated with higher levels of interleukin-6, a marker of myocardial infarction risk and mortality. Adiposity may mediate the increased levels of C-reactive protein, fibrinogen, intercellular adhesion molecule-1, and P-selectin observed in sleep disordered breathing.

Dataset Information

Influence of lung function and sleep-disordered breathing on stroke: a community-based study.

Publications

Influence of lung function and sleep-disordered breathing on stroke: a community-based study.

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