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Epidemiology
Research
Obstructive sleep apnoea and the risk for coronary heart disease and type 2 diabetes: a longitudinal population-based study in Finland
  1. Satu Strausz1,2,3,
  2. Aki S. Havulinna3,4,
  3. Tiinamaija Tuomi3,5,6,
  4. Adel Bachour7,
  5. Leif Groop3,8,
  6. Antti Mäkitie9,
  7. Seppo Koskinen4,
  8. Veikko Salomaa4,
  9. Aarno Palotie3,10,11,12,13,
  10. Samuli Ripatti3,14,
  11. Tuula Palotie1,2
  1. 1 Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
  2. 2 Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  3. 3 Institute for Molecular Medicine Finland (FIMM/HiLIFE), University of Helsinki, Helsinki, Finland
  4. 4 National Institute for Health and Welfare, Helsinki, Finland
  5. 5 Endocrinology, Abdominal Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  6. 6 Diabetes and Obesity Research Program, University of Helsinki and Folkhälsan Research Center, Helsinki, Finland
  7. 7 Sleep Unit, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
  8. 8 Department of Clinical Sciences, Lund University Diabetes Centre, Malmö, Sweden
  9. 9 Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  10. 10 Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  11. 11 Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
  12. 12 Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
  13. 13 The Medical and Population Genomics Program, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
  14. 14 Department of Public Health, University of Helsinki, Helsinki, Finland
  1. Correspondence to Satu Strausz; satu.strausz{at}helsinki.fi

Abstract

Objective To evaluate if obstructive sleep apnoea (OSA) modifies the risk of coronary heart disease, type 2 diabetes (T2D) and diabetic complications in a gender-specific fashion.

Design and setting A longitudinal population-based study with up to 25-year follow-up data on 36 963 individuals (>500 000 person years) from three population-based cohorts: the FINRISK study, the Health 2000 Cohort Study and the Botnia Study.

Main outcome measures Incident coronary heart disease, diabetic kidney disease, T2D and all-cause mortality from the Finnish National Hospital Discharge Register and the Finnish National Causes-of-Death Register.

Results After adjustments for age, sex, region, high-density lipoprotein (HDL) and total cholesterol, current cigarette smoking, body mass index, hypertension, T2D baseline and family history of stroke or myocardial infarction, OSA increased the risk for coronary heart disease (HR=1.36, p=0.0014, 95% CI 1.12 to 1.64), particularly in women (HR=2.01, 95% CI 1.31 to 3.07, p=0.0012). T2D clustered with OSA independently of obesity (HR=1.48, 95% CI 1.26 to 1.73, p=9.11×Embedded Image ). The risk of diabetic kidney disease increased 1.75-fold in patients with OSA (95% CI 1.13 to 2.71, p=0.013). OSA increased the risk for coronary heart disease similarly among patients with T2D and in general population (HR=1.36). All-cause mortality was increased by OSA in diabetic individuals (HR=1.35, 95% CI 1.06 to 1.71, p=0.016).

Conclusion OSA is an independent risk factor for coronary heart disease, T2D and diabetic kidney disease. This effect is more pronounced even in women, who until now have received less attention in diagnosis and treatment of OSA than men.

  • obstructive sleep apnea
  • coronary heart disease
  • type 2 diabetes
  • diabetic kidney disease
  • mortality
  • longitudinal

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-022752

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    Footnotes

    • SR and TP contributed equally.

    • Contributors TP, AP and SR conceived the study and designed the study protocol. SS conducted the literature review, statistical analysis and drafted the manuscript. AH contributed statistical analysis and phenotyped study samples. VS acquired the FINRISK data, TT and LG acquired the Botnia data and SK acquired the Health 2000 data. SS, TP, SR, AP, AH, LG, TT, AM, VS, SK and AB reviewed the manuscript for intellectual content, made revisions as needed and approved the final version for publication. TP, SR and AP supervised the study.

    • Funding This work was supported by Finnish Woman Dentists’ Association, the Finnish Dental Society Apollonia, the Helsinki University Central Hospital Research Funds (HUS 369/2017), Academy of Finland Center of Excellence in Complex Disease Genetics (312062), Academy of Finland (251217 and 285380), The Finnish Foundation for Cardiovascular Research, the Sigrid Juselius Foundation and HiLIFE Fellows grants 2017-2020. The sources of funding had no role in study design, data collection, analyses, interpretation and decision to submit the article for publication. FINRISK surveys have been funded mainly by budgetary funds of the National Institute for Health and Welfare. Additional funding has been obtained as research grants from the Finnish Academy and several domestic foundations. VS was supported by the Finnish Foundation for Cardiovascular Research. The Health 2000 Study is funded by the National Institute for Health and Welfare (THL), the Finnish Centre for Pensions (ETK), The Social Insurance Institution of Finland (KELA), The Local Government Pensions Institution (KEVA) and other organizations listed on the website of the survey (http://www.terveys2000.fi). The Botnia and The PPP-Botnia studies (LG and TT) have been financially supported by grants from Folkhälsan Research Foundation, the Sigrid Juselius Foundation, The Academy of Finland (grants no. 263401, 267882, 312063 to LG, 312072 to TT), Nordic Center of Excellence in Disease Genetics, EU (EXGENESIS, EUFP7-MOSAIC FP7-600914), Ollqvist Foundation, Swedish Cultural Foundation in Finland, Finnish Diabetes Research Foundation, Foundation for Life and Health in Finland, Signe and Ane Gyllenberg Foundation, Finnish Medical Society, Paavo Nurmi Foundation, Helsinki University Central Hospital Research Foundation, Perklén Foundation, Närpes Health Care Foundation and Ahokas Foundation. The study has also been supported by the Ministry of Education in Finland, Municipal Health Care Center and Hospital in Jakobstad and Health Care Centers in Vasa, Närpes and Korsholm.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval FINRISK data are stored in the THL Biobank which distributes them to researchers on the basis of written applications. The Coordinating Ethical Committee of the Helsinki and Uusimaa Hospital District has approved the THL Biobank with the decision # 238/13/03/00/2014. H2000 Study protocol is approved by the Ethical Committee of the National Public Health Institute (decision number 8/99). The Botnia/PPP Botnia Study protocols were approved by the Ethics Committee of the Helsinki University Central Hospital, Finland, with the decision #574/E5/03.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data have been acquired from THL Biobank and are obtainable through the National Institute of Welfare, Finland. Additional information https://thl.fi/en/web/thl-biobank.