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The Sleep Heart Health Study

Terry Young, PhD; Eyal Shahar, MD, MPH; F. Javier Nieto, MD, PhD; Susan Redline, MD, MPH; Anne B. Newman, MD, MPH; Daniel J. Gottlieb, MD, MPH; Joyce A. Walsleben, PhD; Laurel Finn, MS; Paul Enright, MD; Jonathan M. Samet, MD, MS; for the Sleep Heart Health Study Research Group

Arch Intern Med. 2002;162:893-900.

Background  Sleep-disordered breathing (SDB) is common, but largely undiagnosed in the general population. Information on demographic patterns of SDB occurrence and its predictive factors in the general population is needed to target high-risk groups that may benefit from diagnosis.

Methods  The sample comprised 5615 community-dwelling men and women aged between 40 and 98 years who were enrolled in the Sleep Heart Health Study. Data were collected by questionnaire, clinical examinations, and in-home polysomnography. Sleep-disordered breathing status was based on the average number of apnea and hypopnea episodes per hour of sleep (apnea-hypopnea index [AHI]). We used multiple logistic regression modeling to estimate cross-sectional associations of selected participant characteristics with SDB defined by an AHI of 15 or greater.

Results  Male sex, age, body mass index, neck girth, snoring, and repeated breathing pause frequency were independent, significant correlates of an AHI of 15 or greater. People reporting habitual snoring, loud snoring, and frequent breathing pauses were 3 to 4 times more likely to have an AHI of 15 or greater vs an AHI less than 15, but there were weaker associations for other factors with an AHI of 15 or greater. The odds ratios (95% confidence interval) for an AHI of 15 or greater vs an AHI less than 15 were 1.6 and 1.5, respectively, for 1-SD increments in body mass index and neck girth. As age increased, the magnitude of associations for SDB and body habitus, snoring, and breathing pauses decreased.

Conclusions  A significant proportion of occult SDB in the general population would be missed if screening or case finding were based solely on increased body habitus or male sex. Breathing pauses and obesity may be particularly insensitive for identifying SDB in older people. A better understanding of predictive factors for SDB, particularly in older adults, is needed.

From the Department of Population Health Sciences, University of Wisconsin–Madison (Dr Young and Ms Finn); the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (Dr Shahar); the Department of Epidemiology, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md (Drs Nieto and Samet); the Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio (Dr Redline); the Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa (Dr Newman); the Department of Medicine, Boston University School of Medicine, Boston, Mass (Dr Gottlieb); New York University Sleep Disorders Center, New York (Dr Walsleben); and the College of Medicine, University of Arizona, Tucson (Dr Enright).

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