Sleep disordered breathing (SDB) refers to a spectrum of respiratory disturbances during sleep ranging from snoring unaccompanied by Functional impairment to clinically overt sleep apnea syndrome. SDB has been implicated as a risk factor for cardiovascular and cerebrovascular disease (collectively, CVD). Given the high prevalence of undiagnosed SDB in middle-aged adults (9% in women and 24% in men), even a small increase in CVD risk due to SDB would have a substantial public health impact. Although the association between SDB and CVD is widely reported, the causal nature of the relationship, its quantitative importance, and physiologic mechanisms have not been determined. A large population-based epidemiologic study will be performed to investigate prospectively the independent contribution of SDB to the development and progression of SDB. A random stratified sample of 1000 patients drawn from the Framingham Heart Study will undergo home polysomnography to determine SDB status. Construction of multivariate models which include indices of SDB, other known vascular risk factors, age, gender, and race/ethnicity will allow assessment of the individual contribution of SDB to CVD and identification of the population subgroups at highest risk. Urinary catecholamine excretion will be included in the models to test the hypothesis that activation of the sympathetic nervous system mediates the increased CVD risk due to SDB. Spirometry will be included to determine the extent to which the level of ventilatory faction modifies the risk of CVD associated with SDB.
| Givelber, R J; Couropmitree, N N; Gottlieb, D J et al. (1998) Segregation analysis of pulmonary function among families in the Framingham Study. Am J Respir Crit Care Med 157:1445-51 |
