Chest
Volume 130, Issue 3, September 2006, Pages 766-773
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Original Research: Sleep Medicine
Low Socioeconomic Status Is a Risk Factor for Cardiovascular Disease Among Adult Obstructive Sleep Apnea Syndrome Patients Requiring Treatment

https://doi.org/10.1378/chest.130.3.766Get rights and content

Study objective

To evaluate the possible role of low socioeconomic status (SES) as a risk factor for cardiovascular disease (CVD) among obstructive sleep apnea syndrome (OSAS) patients requiring treatment.

Design

Polysomnographic and demographic characteristics and associated morbidity were measured in 686 prospectively recruited adult OSAS patients from two regions in Israel.

Setting

Two university-affiliated sleep laboratories.

Measurements and results

The multiple logistic regression (after adjusting for gender, body mass index [BMI], and smoking) revealed that the following are independent determinants for CVD in OSAS patients requiring treatment: each decrease in income level category (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1 to 1.7), age ≥ 1 year (OR, 1.07; 95% CI, 1.04 to 1.1), hypertension (OR, 2.0; 95% CI, 1.3 to 3.1), and hyperlipidemia (OR, 3.7; 95% CI, 2.4 to 5.8); area under the receiver operating characteristic (ROC) = 81.9%. The multivariate determinants describing the low-SES OSAS patients included: minorities and immigrants combined (OR, 6.0; 95% CI, 2.9 to 12), female gender (OR, 2.4; 95% CI, 1.6 to 3.9), increased BMI (OR, 1.9; 95% CI, 1.3 to 2.9), unmarried status (OR, 1.9; 95% CI, 1.2 to 3.1), and years of education (≥ 1 year) [OR, 0.8; 95% CI, 0.7 to 0.8]; area under the ROC = 78.1%.

Conclusion

In addition to the already known traditional risk factors, low SES was found to be a novel independent risk factor for CVD among adult OSAS patients requiring treatment.

Section snippets

Study Design and Population

This study began in June 2003 in two universities with affiliated sleep-wake disorders centers. Prospective data were collected on consecutively recruited OSAS patients aged ≥ 18 years requiring treatment who underwent polysomnography and a healthy control group during the 13-month study period.

To reconfirm morbidity among OSAS patients, we compared 686 patients with OSAS to healthy subjects matched 1:1 by age, gender, geographic location, and family physician (p = 0.999). The control group was

RESULTS

A total of 1,214 subjects underwent polysomnography during the 13-month study period. Of those, 116 patients (9.6%) refused to participate in the study and 79 patients (6.5%) did not meet the inclusion criteria. Therefore, 1,019 patients were eligible for the study. Following polysomnography, 333 patients (32.7%) did not meet the inclusion criteria of OSAS severity. Finally, the study population included 686 OSAS patients requiring treatment. Of those, 364 patients (53.1%) had an AHI ≥ 30 (99,

DISCUSSION

The main novel finding of our study is that in addition to the already known traditional risk factors (age, gender, BMI, hypertension, and hyperlipidemia), low SES is an independent risk factor for CVD among OSAS patients requiring treatment.

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    Institute for Health Policy and Health Services Research, award No. B/17/2000.

    The authors declare that they have no financial conflict of interest with any manufacturers or products mentioned in this article.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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