Sleep apnea is independently associated with peripheral arterial disease in the Hispanic Community Health Study/Study of Latinos

Arterioscler Thromb Vasc Biol. 2015 Mar;35(3):710-5. doi: 10.1161/ATVBAHA.114.304625. Epub 2015 Feb 5.


Objective: Sleep apnea (SA) has been linked with various forms of cardiovascular disease, but little is known about its association with peripheral artery disease (PAD) measured using the ankle-brachial index. This relationship was evaluated in the Hispanic Community Health Study/Study of Latinos.

Approach and results: We studied 8367 Hispanic Community Health Study/Study of Latinos participants who were 45 to 74 years of age. Sleep symptoms were examined with the self-reported Sleep Health Questionnaire. SA was assessed using an in-home sleep study. Systolic blood pressure was measured in all extremities to compute the ankle-brachial index. PAD was defined as ankle-brachial index <0.90 in either leg. Multivariable logistic regression was used to investigate the association between moderate-to-severe SA, defined as apnea-hypopnea index ≥15, and the presence of PAD. Analyses were adjusted for covariates. The prevalence of PAD was 4.7% (n=390). The mean apnea-hypopnea index was significantly higher among adults with PAD compared with those without (11.1 versus 8.6 events/h; P=0.046). After adjusting for covariates, moderate-to-severe SA was associated with a 70% increase in the odds of PAD (odds ratio, 1.7; 95% confidence interval, 1.1-2.5; P=0.0152). This association was not modified by sex (P=0.8739). However, there was evidence that the association between moderate-to-severe SA and PAD varied by Hispanic/Latino background (P<0.01). Specifically, the odds were stronger in Mexican (adjusted odds ratio, 2.9; 95% confidence interval, 1.3-6.2) and in Puerto Rican Americans (adjusted odds ratio, 2.0; 95% confidence interval, 0.97-4.2) than in other backgrounds.

Conclusions: Moderate-to-severe SA is associated with higher odds of PAD in Hispanic/Latino adults.

Keywords: Hispanic Americans; ankle–brachial index; atherosclerosis; peripheral arterial disease; sleep apnea syndromes.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Ankle Brachial Index
  • Chi-Square Distribution
  • Comorbidity
  • Female
  • Hispanic or Latino*
  • Humans
  • Logistic Models
  • Male
  • Mexican Americans
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Peripheral Arterial Disease / diagnosis
  • Peripheral Arterial Disease / ethnology*
  • Puerto Rico / ethnology
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Sleep Apnea Syndromes / diagnosis
  • Sleep Apnea Syndromes / ethnology*
  • Surveys and Questionnaires
  • United States / epidemiology