Association of incident angina pectoris and rapid eye movement sleep in a large community-based study: the sleep heart health study

Background: Sleep-disordered breathing may precipitate angina pectoris (AP) in rapid eye movement (REM) sleep. The purpose of this study was to investigate whether REM sleep is associated with the incidence of AP in different categories of apnea-hypopnea index (AHI). Methods: A total of 2710 participants from Sleep Heart Health Study (59.3% women; mean age 61.7 years), who had 6-8 h of sleep; experienced an almost 11-year follow-up period. Complete polysomnography data and medical records were available for all participants. Percentage of REM sleep time (REM%) was classified into grade 1 (< 20%), grade 2 (20e25%) and grade 3 (> 25%). Logistic regression analysis was used to characterize the independent association between REM sleep and prevalent AP in this multi-center community-based cohort study. Results: Patients with REM% of grade 3 had a higher incidence of AP than those with grade 1 and grade 2 (50.3% vs 42.4% vs 42.1%, respectively; p = 0.003). After adjusting for age, gender, race, AHI, marital status, education level, body mass index, sleep duration, arousal index, diabetes, hypertension and smoking status, multivariate logistic regression analysis revealed that REM% > 25% was independently associated with the occurrence of AP (odds ratio = 1.500; 95% confidence interval = 1.188-1.894; p = 0.001). Conclusions: The percentage of REM sleep time may affect the incidence of AP irrespective of AHI level. Therefore, the relationship between sleep structure and cardiovascular disease merits further exploration. (C) 2018 Elsevier B.V. All rights reserved.