Self-reported sleep tendency poorly predicts the presence of obstructive sleep apnea in commercial truck drivers.

BACKGROUND AND OBJECTIVES: Drowsy driving increases the risk of motor vehicle crashes in those with untreated obstructive sleep apnea (OSA). Although previous studies indicated that excessive daytime sleepiness (EDS) might not predict OSA, they were not conclusive due to their small study sizes or restricted participants to sleep clinic patients. The overall objective was to determine whether self-reported EDS can be used for case identification of OSA among commercial truck drivers. METHODS: Commercial truck drivers (N = 19,699) were screened for OSA-related symptoms. EDS was determined using the Epworth Sleepiness Scale (ESS) ≥ 11 and all participants completed the home sleep apnea test using a type 4 portable monitor to derive the respiratory event index (REI). Regression analyses were used to characterize the association between EDS and REI. RESULTS: EDS was associated with OSA severity (p for trend <0.001). The sensitivity and specificity values of EDS for identifying moderate-to-severe OSA (REI ≥15 events/hour) were 0.10 and 0.93, respectively, and 0.48 and 0.71 if BMI ≥25 kg/m2 was added. Those using BMI ≥25 kg/m2 with OSA-related signs yielded the best sensitivity and specificity of 0.77 and 0.50, which were not improved by the addition of EDS. CONCLUSIONS: Despite the associations between EDS and OSA severity and between OSA and lethal crash, case-identification of OSA using the ESS in commercial truck drivers is poor. Thus, OSA screening strategy may need a special approach, including a hierarchical combination of screening tools (Swiss Cheese Model approach), and incorporation of home sleep apnea testing.

Continuous positive airway pressure alleviates insomnia in workers sleeping near other workers with sleep apnea after the Fukushima Nuclear Power Plant disaster.

OBJECTIVES: To examine the efficacy of continuous positive airway pressure for improving the sleep of all individuals residing in a temporary shelter. METHODS: Workers at a nuclear power plant using a gymnasium as temporary shelter were divided into two groups: 15 workers with obstructive sleep apnea received continuous positive airway pressure treatment, and 107 workers without obstructive sleep apnea received no treatment. We assessed subjective sleepiness among the workers with obstructive sleep apnea before and after continuous positive airway pressure treatment, and evaluated insomnia in all workers before and after workers with obstructive sleep apnea were given continuous positive airway pressure treatment. RESULTS: Workers who received continuous positive airway pressure treatment reported significantly improved subjective sleepiness, but did not experience a significant change in insomnia symptoms. However, workers without obstructive sleep apnea reported significant improvements in their insomnia symptoms following the treatment of workers with obstructive sleep apnea. CONCLUSIONS: Using continuous positive airway pressure to treat workers with obstructive sleep apnea residing in temporary shelters may help prevent adverse health consequences from insomnia among other individuals sleeping nearby.

The association of coffee consumption and oxygen desaturation index during sleep among Japanese male workers.

BACKGROUND AND OBJECTIVE: Coffee is a major caffeine-containing food source that can be used for treatment of apnea in prematurity. However, few studies have examined the association between coffee consumption and sleep-disordered breathing (SDB). We investigated whether coffee consumption is associated with the oxygen desaturation index (ODI) as a marker of SDB among middle-aged Japanese male workers. METHODS: The subjects were 1126 male local government workers aged 22-59 who participated in SDB screening in 2011-2012. Daily coffee consumption was assessed by a self-administered questionnaire. We measured 3% oxygen desaturation (3%ODI) during a night's sleep using a pulse oximeter. A general linear model was used to calculate the multivariate-adjusted means of 3%ODI per quartile of coffee consumption. We further analyzed the data after stratifying by overweight and current smoking status. RESULTS: A inverse association between coffee consumption and 3%ODI was found. The multivariate-adjusted mean of 3%ODI for the lowest and highest coffee consumption groups were 11.9 times/h and 10.6 times/h (p for trend = 0.06), respectively; 14.6 and 11.5 times/h (p for trend = 0.01) in overweight participants; and 12.7 and 11.0 times/h (p for trend = 0.06) in non-smokers. No associations were found in non-overweight and smoking workers. CONCLUSIONS: Our results suggest that higher coffee consumption was associated with lower 3% ODI as a marker of SDB in overweight and non-smoking workers.

Associations of serum ß-carotene and retinol concentrations with insulin resistance: the Toon Health Study.

OBJECTIVE: Although green and yellow vegetables have beneficial effects against type 2 diabetes, the relationship of their nutritive content with insulin resistance is poorly understood. The aim of this study was to examine the associations of serum ß-carotene and retinol concentrations with glucose and insulin concentrations. METHODS: We recruited 951 Japanese men and women ages 30 to 79 y who were not undergoing treatment for diabetes and measured their serum ß-carotene and retinol concentrations. A 75-g oral glucose tolerance test was performed and the homeostasis model assessment for insulin resistance (HOMA-IR) and the Matsuda Index were calculated as measures of insulin resistance. Several confounding factors were adjusted for with multivariable logistic models. RESULTS: Multivariable-adjusted odds ratios of the highest quartile of serum ß-carotene compared with the lowest quartile for HOMA-IR >1.6 and Matsuda Index <4.9 were 0.56 (95% confidence interval, 0.34-0.94) and 0.62 (0.37-1.02), respectively. When stratified by sex and overweight status, these associations were observed for women and non-overweight individuals. Serum retinol concentration was not associated with either index. Furthermore, according to the nutritional survey, serum ß-carotene concentration was associated with green and yellow vegetable intake (P = 0.01). CONCLUSION: Our findings suggest that higher serum ß-carotene levels, associated with higher intake of green and yellow vegetables, confer beneficial effects against insulin resistance.

The impact of masticatory ability as evaluated by salivary flow rates on obesity in Japanese: The Toon health study.

OBJECTIVE: This study examined the associations of masticatory ability evaluated by chewing-gum-stimulated salivary flow rate with anthropometric indices among a general Japanese population. METHODS: In total, 921 Japanese men and women aged 30-79 years participated in this cross-sectional study. Saliva production was stimulated by 5 min of gum chewing, then collected; salivary flow rate was calculated as g/min. Overweight, abdominal obesity in terms of waist circumference (WC), and waist-hip ratio (WHR), and elevated skinfold thickness statuses were determined. RESULTS: The multivariable odds ratio and 95% confidence intervals of overweight, abdominal obesity (WC, WHR), and elevated skinfold thickness status for highest vs. lowest quartile of salivary flow rate were 0.59 (0.37-0.95, P for trend = 0.02), 0.65 (0.43-0.98, P = 0.03), 0.54 (0.35-0.83, P < 0.01), and 0.61 (0.39-0.96, P < 0.01), respectively. The linear trends of multivariable-adjusted means of BMI, WC, WHR, and skinfold thickness according to quartiles of salivary flow rate did not vary after stratification by overweight status. CONCLUSIONS: Higher stimulated salivary flow rate, a surrogate marker for mastication ability, was associated with lower prevalence of overweight, abdominal obesity (whether WC- or WHR-defined), and elevated skinfold thickness among the general Japanese population.

Sleep-related intermittent hypoxemia and glucose intolerance: a community-based study.

BACKGROUND: Intermittent hypoxemia is a fundamental pathophysiological consequence of sleep-disordered breathing and may alter glucose metabolism. To characterize the association between sleep-related intermittent hypoxemia and glucose metabolism, overnight pulse-oximetry and an oral glucose tolerance test were completed in a cohort of middle-aged and older Japanese adults. METHODS: The study sample consisted of 1836 community-dwelling Japanese (age, 30-79 years; women, 65.5%; mean body mass index, 23.1 kg/m(2)). The oxygen desaturation index (ODI) was quantified during sleep using a ≥3% oxygen desaturation threshold and categorized as normal (<5.0 events/h), mild (5.0-15.0 events/h), and moderate to severe (≥15.0 events/h). The independent associations between the ODI and the prevalence of impaired fasting glucose, impaired glucose tolerance, diabetes, and two metrics of insulin resistance [homeostasis model assessment index for insulin resistance (HOMA-IR) and Matsuda index] were examined. RESULTS: Compared with subjects with an ODI < 5 events/h, the adjusted odds ratio for prevalent impaired fasting glucose, glucose intolerance, and diabetes for subjects with an ODI ≥15.0 events/h were 1.27 (95% confidence interval, 0.72-2.23), 1.69 (1.03-2.76), and 1.28 (0.59-2.79), respectively. Both HOMA-IR and Matsuda index were significantly associated with the severity of sleep-related intermittent hypoxemia as assessed by the ODI (P for trend = 0.03 and 0.007, respectively). CONCLUSION: Among middle-aged and older Japanese adults, sleep-related intermittent hypoxemia is associated with glucose intolerance and insulin resistance, and may contribute to the development of type 2 diabetes mellitus.

Relationships between nocturnal intermittent hypoxia, arterial stiffness and cardiovascular risk factors in a community-based population: the Toon health study.

AIM: Nocturnal intermittent hypoxia (NIH), a primary marker of obstructive sleep apnea, has increasingly been linked with cardiovascular morbidity and mortality. The purpose of this study was to investigate the association between NIH and arterial stiffness as measured according to the cardio-ankle vascular index (CAVI) based on cardiovascular risk factors in a Japanese community-dwelling population. METHODS: We conducted a cross-sectional study in Toon city among 684 men and 1,241 women 30-79 years of age. The severity of NIH was defined as mild or moderate-to-severe according to five or 15 events/hour on the 3% oxygen desaturation index (ODI), respectively. Increased arterial stiffness was diagnosed according to a CAVI of ≥9. RESULTS: The number of subjects with no, mild and moderate-to-severe NIH was 1,348 (70%), 451 (23%) and 126 (7%), respectively. Increased arterial stiffness was detected in 21.9% of the participants. The multivariable-adjusted odds ratio (95% CI) of severe NIH related to an increased CAVI in comparison with a 3% ODI of <5 was 1.36 (0.82-2.23). The stratified logistic regression analysis showed that the multivariable-adjusted OR of severe NIH for an increased CAVI was remarkably increased in the individuals with a BMI of ≥25 (OR=2.53, 1.08-5.96; p=0.03). An interaction test showed a trend for an overweight status to be a modifier of the association between OSA and increased arterial stiffness (p=0.05). CONCLUSIONS: NIH has a tendency to promote increased arterial stiffness as measured according to the CAVI, especially in overweight subjects.

Nocturnal intermittent hypoxia as an associated risk factor for microalbuminuria in Japanese patients with type 2 diabetes mellitus.

OBJECTIVE: We estimated the prevalence of nocturnal intermittent hypoxia, a surrogate marker of obstructive sleep apnoea, among type 2 diabetes mellitus (T2DM) patients and examined the association between nocturnal intermittent hypoxia and microvascular diseases. DESIGN AND METHODS: We recruited 513 Japanese patients (292 men and 221 women) with T2DM. Nocturnal intermittent hypoxia was diagnosed using the 3% oxygen desaturation index, with less than five events per hour corresponding to normal and five events or more per hour corresponding to nocturnal intermittent hypoxia. RESULTS: The prevalence of nocturnal intermittent hypoxia was 45.4% among T2DM patients. The nocturnal intermittent hypoxia group was older and had a higher BMI, greater weight change since the age of 20 years, higher smoking rate and increased prevalence of hypertension, hyperlipidaemia, microalbuminuria and macroalbuminuria. Microalbuminuria (model 1: odds ratio (OR), 3.41; 95% CI, 1.85-6.40; model 2: OR, 3.69; 95% CI, 1.85-7.59 and model 3: OR, 3.12; 95% CI, 1.45-6.95) and nephropathy (model 1: OR, 4.51; 95% CI, 1.58-15.1; model 2: OR, 7.31; 95% CI, 2.11-31.6 and model 3: OR, 5.23; 95% CI, 1.45-23.8) were derived as factors from all the three statistical models and constantly associated with nocturnal intermittent hypoxia only in women. CONCLUSIONS: Nocturnal intermittent hypoxia was highly prevalent among T2DM patients and may be an independent associated risk factor for microalbuminuria in Japanese women with T2DM.

Association of hematological parameters with insulin resistance, insulin sensitivity, and asymptomatic cerebrovascular damage: the J-SHIP and Toon Health Study.

BACKGROUND: Elevated hematocrit levels have been suggested to be an independent determinant of insulin resistance and type 2 diabetes. To clarify the diagnostic significance of hematocrit level, we investigated the association with hemodynamic profiles, insulin resistance and insulin sensitivity, arterial properties, and asymptomatic cerebrovascular damage in a general Japanese population. METHODS: This study included 1,978 participants from two independent cohorts. Insulin sensitivity was assessed by the oral 75 g glucose tolerance test. Carotid ultrasonography was performed to evaluate atherosclerosis and wall shear stress. Periventricular hyperintensity and lacunar infarction were assessed by brain magnetic resonance imaging. RESULTS: Hematocrit quartile showed a stepwise association with insulin sensitivity (Q1: 2.2±0.7, Q2: 2.0±0.7, Q3: 1.9±0.7, Q4: 1.8±0.6, p<0.001) and insulin resistance (1.0±0.6, 1.2±0.7, 1.3±0.8, 1.5±1.0, p<0.001). Multiple linear regression analysis adjusted for possible covariates identified hematocrit as an independent determinant of insulin sensitivity (ß=-0.074, p=0.019) and insulin resistance (ß=0.115, p<0.001). However, this association was lost after further adjustment for visceral fat area and plasma alanine aminotransferase level. Further, no significant association was observed between hematocrit and carotid intima-media thickness (p=0.306) where as wall shear stress was inversely associated with the carotid atherosclerosis (r=-0.250, p<0.001). In contrast, a low hematocrit level was independently associated with periventricular hyperintensity (odds ratio 0.87 (95% CI 0.80-0.95), p=0.001). CONCLUSION: Hematocrit was positively associated with insulin resistance and insulin sensitivity. This association was epiphenomenon of visceral and hepatic adiposity. Conversely, low hematocrit was a significant risk factor for periventricular hyperintensity independent of insulin resistance.

Self-reported snoring frequency and incidence of cardiovascular disease: the Circulatory Risk in Communities Study (CIRCS).

BACKGROUND: Although associations between snoring and cardiovascular disease have been reported in several prospective studies, there is limited evidence from Asian populations. The objective of this study was to determine if there is an association between self-reported snoring frequency and the incidence of cardiovascular disease in Japanese. METHODS: The subjects were 2350 men and 4163 women aged 40 to 69 years who lived in 3 communities in Japan. All subjects were participants in the Circulatory Risk in Communities Study (CIRCS) and were followed for 6 years. Incidence of cardiovascular disease during the follow-up period comprised events of myocardial infarction, angina pectoris, sudden cardiac death and stroke. RESULTS: During the 6-year follow-up period, 97 participants (56 men and 41 women) had cardiovascular events. After adjustment for potential confounding factors, self-reported snoring frequency was associated with an increased risk of cardiovascular events among women but not men. The hazard ratios (95% CI) for cardiovascular events were 0.9 (0.4-2.0) for sometimes snoring and 2.5 (1.0-6.1) for everyday snoring in women and 0.7 (0.3-1.3) and 1.0 (0.5-2.1), respectively, in men. Further adjustment for body mass index attenuated the association in women; the respective hazard ratios for cardiovascular events were 0.9 (0.4-1.9) and 2.1 (0.9-5.4). CONCLUSIONS: Self-reported habitual snoring was associated with increased risk of cardiovascular events among Japanese women. Overweight may partly mediate this association.

Relatively lower central aortic pressure in patients with impaired insulin sensitivity and resistance: the Toon Health Study.

OBJECTIVE: Central aortic blood pressure (BP) has been postulated to correlate more closely with cardiovascular disease risk than brachial cuff BP. However, the effect of insulin sensitivity and resistance on central BP is not fully understood. Here, we evaluated the associations between insulin sensitivity/resistance and central BP using the oral glucose tolerance test. METHODS: A total of 1034 Japanese participants were enrolled in this study. The absolute pressure of the late systolic peak (SBP2) of the brachial BP obtained by the radial waveform was considered to be the central systolic BP. Oral glucose tolerance test was performed by administering 75 g of glucose, and blood samples were obtained at 0, 60, 120 min after glucose loading. RESULTS: Mean SBP2 was found to be lower than mean brachial systolic BP (SBP) (119 ±â€Š20, 126 ±â€Š19 mmHg, P < 0.001), and differences between SBP and SBP2 were significantly larger in patients with reduced insulin sensitivity (-8.2 ±â€Š5.2, -7.2 ±â€Š5.3, -7.1 ±â€Š5.1, and -6.5 ±â€Š4.9 mmHg, in the first, second, third and fourth quartiles, respectively; P = 0.002) and increased insulin resistance (-6.6 ±â€Š5.1, -6.6 ±â€Š4.8, -7.3 ±â€Š4.8, -8.5 ±â€Š5.6 mmHg, P < 0.001). Multiple linear regression analysis identified reduced insulin sensitivity (ß = 0.067, P = 0.033) and increased insulin resistance (ß = -0.081, P = 0.009) as independent determinants of the difference between SBP and SBP2. CONCLUSION: Given that both insulin sensitivity and insulin resistance were found to be significant determinants of the difference between SBP and SBP2 in a healthy general population, we suggest measuring the SBP2 in individuals with impaired insulin action in order to accurately assess their risk of developing cardiovascular disease.

Risk factors for snoring among Japanese men and women: a community-based cross-sectional study.

PURPOSE: This study seeks to examine risk factors for snoring, a major symptom of sleep-disordered breathing (SDB) because the evidence is limited in Asian populations. METHODS: Subjects for the present cross-sectional study were 3,138 men and 5,345 women aged 35­79 years from three communities in Japan who participated in the Circulatory Risk in Communities Study. The data on snoring frequency and cardiovascular health were obtained during annual cardiovascular surveys between 2000 and 2005. The logistic regression model was used to estimate the odds ratios (ORs) for snoring associated with body mass index (BMI), alcohol consumption, and other cardiovascular risk factors. RESULTS: The prevalence of almost everyday snoring was 24% among men and 10% among women. After adjustments for age, community, cigarette smoking, alcohol consumption, and for women, menopausal status, the multivariable-adjusted ORs for everyday snoring in the highest versus lowest quartiles of BMI categories were 3.4 (95% confidence interval (CI): 2.6­4.4) for men and 3.9 (2.8­5.4) for women. The respective ORs in ≥23 g ethanol per day versus never-drinkers categories were 1.4 (1.1­1.8) and 3.1 (1.8­5.3) and those in ≥20 cigarettes versus never-smokers categories were 1.4 (1.0­1.8) and 1.9 (0.9­3.7). The associations of alcohol consumption and cigarette smoking with everyday snoring were stronger for BMI<25 kg/m2 than BMI≥25 kg/m2 in both sexes. CONCLUSION: BMI, alcohol consumption, and cigarette smoking were positively associated with habitual snoring for both men and women, especially in nonoverweight persons.

Associations between alcohol consumption and sleep-disordered breathing among Japanese women.

BACKGROUND: The associations between alcohol consumption and sleep-disordered breathing in women are uncertain. METHODS: We conducted a cross-sectional study of 3113 women aged 30-69 years. The 3% oxygen desaturation index (3% ODI), based on overnight pulse oximetry findings, was selected as an indicator of sleep-disordered breathing. RESULTS: 3% ODI frequencies of ≥5 were higher for drinking women with ethanol intakes of ≥23.0 g/d than for never drinkers: the respective multivariable odds ratios and 95% confidence intervals was 1.8(1.0-3.4). The corresponding odds ratio was 3.0(1.6-5.8) for habitual snoring. The associations of ethanol intakes of ≥23.0 g/d with 3% ODI ≥ 5 was more evident among women with BMI <23.0 kg/m(2) (median) than those with higher BMI but did not vary by habitual snoring. The multivariable odds ratios of 3%ODI ≥ 5 for women with ethanol intakes of ≥23.0 g/d versus never drinkers were 2.7(1.0-6.7) for lower BMI and 1.5(0.6-3.3) for higher BMI and the corresponding odds ratio were 2.8(1.6-7.2) and 3.2(1.3-7.9) for habitual snoring, respectively. CONCLUSION: Alcohol consumption was associated with higher prevalence of sleep-disordered breathing among Japanese women.

Nocturnal intermittent hypoxia and C reactive protein among middle-aged community residents: a cross-sectional survey.

BACKGROUND: There are conflicting results for the association between obstructive sleep apnoea and raised C reactive protein (CRP) levels. A study was undertaken to investigate whether nocturnal intermittent hypoxia, a surrogate marker for obstructive sleep apnoea, was associated with CRP levels among a community-dwelling Japanese population. METHODS: Among participants in the Circulatory Risk in Communities Study (CIRCS), 1422 male and 2466 female community residents aged 40-69 years were tested during sleep. No nocturnal intermittent hypoxia, mild nocturnal intermittent hypoxia and moderate to severe nocturnal intermittent hypoxia were defined using 3% oxygen desaturation index cut-off points at 5 and 15 events/h, respectively. High-sensitivity CRP levels were measured using a latex particle-enhanced immunonephelometric assay. Multivariate analysis was adjusted for age, sex, body mass index, smoking status, current alcohol intake, hypertension, hypercholesterolaemia, diabetes mellitus and menopausal status for women. RESULTS: Multivariable-adjusted mean CRP levels among men were 0.70 mg/l (95% CI 0.65 to 0.75) for no nocturnal intermittent hypoxia, 0.82 mg/l (95% CI 0.74 to 0.89) for mild nocturnal intermittent hypoxia and 0.84 mg/l (95% CI 0.70 to 1.00) for moderate to severe nocturnal intermittent hypoxia (p for trend=0.03). The values for women were 0.59 mg/l (95% CI 0.57 to 0.62), 0.66 mg/l (95% CI 0.59 to 0.73) and 0.82 mg/l (95% CI 0.62 to 1.03), respectively (p for trend=0.008). Compared with no nocturnal intermittent hypoxia, the prevalence of a high CRP level (>or=1.0 mg/l) was 1.4-1.7-fold higher for mild to severe nocturnal intermittent hypoxia in both sexes. CONCLUSIONS: Nocturnal intermittent hypoxia is associated with raised serum CRP levels among middle-aged Japanese subjects.

Urea nitrogen concentrations in spot urine, estimated protein intake and blood pressure levels in a Japanese general population.

BACKGROUND: An inverse association between total protein intake and blood pressure has been reported in Western countries. Such evidence is limited in the Japanese population, however, whose major protein sources are plants and seafood. METHODS: We conducted a population-based cross-sectional study of 986 men and 1,636 women, aged 40-74 years, in a Japanese rural community to examine the association between blood pressure levels and urea nitrogen concentrations in spot urine. RESULTS: The concentration of urea nitrogen in spot urine, an indicator of total protein intake that was validated by 24-h urea nitrogen excretion and 24-h dietary research, was inversely associated with systolic blood pressure levels for men: a 238 mg/dl increase in urea nitrogen concentration was associated with a 2.1 mm Hg lower mean systolic blood pressure. For women, a weaker and nonsignificant inverse association was observed. There was no association between urea nitrogen concentrations and diastolic blood pressure levels in either sex. Total protein intake estimated from spot urine was also inversely associated with systolic blood pressure levels for men: a 19.2 g/day increase in estimated protein intake was associated with a 1.5 mm Hg lower mean systolic blood pressure. CONCLUSION: A urinary biomarker for total protein intake was inversely associated with systolic blood pressure levels for men in a Japanese general population.

Nocturnal intermittent hypoxia and metabolic syndrome; the effect of being overweight: the CIRCS study.

AIM: We investigated whether nocturnal intermittent hypoxia, a surrogate marker for obstructive sleep apnea, is associated with metabolic syndrome and its components among Japanese. METHODS: We examined 1,710 male and 2,896 female community-dwelling Japanese aged 40 to 69, who participated in annual cardiovascular examinations and investigations of sleep. Nocturnal intermittent hypoxia was estimated based on a 3% oxygen desaturation index measured with pulse-oximetry during sleep. No, mild and moderate-to-severe nocturnal intermittent hypoxia were defined by <5, 5 to <15 and >or=15 events/hour, respectively. Metabolic syndrome was defined by modified criteria of the Adult Treatment Panel III guidelines. RESULTS: Compared with no nocturnal intermittent hypoxia, the multivariable odds ratio of metabolic syndrome was 1.9 (95% confidence interval: 1.6-2.4) for mild and 3.2 (2.2-4.7) for moderate-to-severe nocturnal intermittent hypoxia among men; 2.6 (2.1-3.4) and 5.8 (3.4-9.8) among women, respectively. When stratified by overweight status (body mass index >or=25 kg/m(2)), the multivariable odds ratio of two or more metabolic risk factors (other than overweight) associated with moderate-to-severe nocturnal intermittent hypoxia was 1.9 (1.2-3.1) among non-overweight subjects and 1.4 (0.9-2.1) among overweight subjects (p for interaction=0.002). CONCLUSIONS: Nocturnal intermittent hypoxia was associated with the accumulation of metabolic risk factors, especially among non-overweight individuals.

Relationships of soluble E-selectin and high-sensitivity C-reactive protein with carotid atherosclerosis in Japanese men.

AIM: E-selectin and C-reactive protein have been linked with carotid atherosclerosis; however, the findings on this association have been inconsistent. METHODS AND RESULTS: We conducted a cross-sectional study to examine the associations of soluble E-selectin (sE-selectin) and high-sensitivity-CRP (hs-CRP) levels with carotid intima-media thickness (IMT) in 505 Japanese men aged 60-74 years. Maximum IMT of common (CCA) and internal carotid arteries (ICA) was positively associated with sE-selectin levels after adjustment for age, hs-CRP and other cardiovascular risk factors: means of maximum CCA IMT were 1.12, 1.21 and 1.27 mm for the lowest to highest tertiles of sE-selectin, respectively, p=0.04, and those of ICA IMT were 1.73, 2.09 and 2.09 mm, respectively, p=0.009. Maximum IMT of CCA tended to be positively associated hs-CRP levels after adjustment for age, sE-selectin and other cardiovascular risk factors: means of maximum CCA IMT were 1.10, 1.25, and 1.26 mm, for the lowest to highest tertiles of hs-CRP, respectively, p=0.06. Compared with subjects with the lowest tertiles of sE-selectin and hs-CRP, those with the highest tertiles had a higher prevalence of heterogeneous plaque: multivariable odds ratios were 2.2 (1.03.7), p=0.002 and 1.6 (1.02.7), p=0.046, respectively. CONCLUSIONS: Serum levels of sE-selectin and hs-CRP could be biomarkers for atherosclerosis in general populations.

Associations between cardiovascular risk factors and carotid atherosclerosis in middle-aged Japanese men with multiple risk factors.

To examine the relationship between cardiovascular risk factors and prevalence of carotid atherosclerosis in Japanese middle-aged men with multiple risk factors, 110 Japanese men aged 36 to 60 yr were recruited based on the presence of all of the following factors detected during a screening survey: 1) body mass index (BMI) > or = 25 kg/m2; 2) systolic blood pressure (SBP) > or = 140 mmHg and/or diastolic blood pressure > or = 90 mmHg; 3) serum levels of triglycerides (TG) > or = 150 mg/dl and/or total cholesterol (T-ChoL) levels > or = 220 mg/dl and/or high density lipoprotein cholesterol (HDL-C) levels < 40 mg/dl; and 4) fasting serum glucose > or = 110 mg/dl and/or hemoglobin A1C > or = 5.6%. After adjustment for age and cardiovascular risk factors, the odds ratio (95% confidence interval) of carotid atherosclerosis associated with a 1-SD increment in HDL-C was 0.4 (95%CI: 0.2 to 0.9). We also detected a borderline association for anti-hypertension medication use, an indicator for advanced hypertension, with an odds ratio of 2.7 (95%CI: 1.0 to 7.4) after multivariable adjustment. The other risk factors, i.e. BMI, SBP, T-ChoL, TG, diabetes, smoking and drinking status did not show significant associations with carotid atherosclerosis. In conclusion, low HDL-C and advanced hypertension were significant correlates of carotid atherosclerosis for middle-aged Japanese men with multiple risk factors.

Associations of sleep-disordered breathing with excessive daytime sleepiness and blood pressure in Japanese women.

Sleep-disordered breathing (SDB) is a recognized risk factor for excessive daytime sleepiness (EDS) and hypertension, but evidence of this association in Asian women is limited. We conducted a cross-sectional study of 3,568 women aged 30-69 years living in three Japanese communities. The 3% oxygen desaturation index (ODI) was selected as the indicator of SDB, and blood oxygen fall was estimated by overnight pulse oximetry. The prevalence of SDB was 20.2% for 3% ODI>or=5, 6.4% for 3% ODI>or=10, and 2.8% for 3% ODI>or=15 among Japanese women aged 30-69 years. The 3% ODI was positively associated with the prevalence of self-reported EDS and mean values of systolic and diastolic blood pressure levels. The multivariate odds ratios for 3% ODI of 5-9, 10-14, and >or=15 in reference to 3% ODI<5 were 1.9 (1.2-3.0), 2.2 (1.0-4.6), and 1.8 (0.7-4.4) (p for trend=0.01), respectively, for EDS and 1.1 (0.9-1.4), 1.2 (0.8-1.8), and 2.2 (1.4-3.4) (p for trend<0.001), respectively, for hypertension. The severity of SDB was significantly associated with EDS and hypertension among Japanese women.