The past year has been quite exciting for the Sleep Heart
Health Study. Earlier this year, the study received notification from the National
Institutes of Health that it was refunded for another 5 years! This second cycle of
funding which started in September of 1999, has triggered several administrative
changes. First, our central data coordinating center has moved from the University of
Washington to Johns Hopkins University. Second, our colleagues representing Native
American Indian tribes in the Dakotas, Oklahoma and the Phoenix area have become a
separate field center. Previously, they were part of the University of Arizona's field
center. Finally, the author of this article and principal investigator of the University
of Arizona's field center was selected to be chairman of the central SHHS steering
committee. Despite this administrative reorganization, the study remains committed to
investigating the relationship between obstructive sleep apnea and cardiovascular disease.
We are currently planning our next examination cycle which will start in November of 2000.
We look forward to working with you at that time.
The study has completed work on several manuscripts which have been published or will
be published soon. Dr. Daniel Gottlieb from SHHS's Boston University/ Framingham,
MA field center has published a paper demonstrating that excessive daytime
sleepiness progressively increases with the number of breathing pauses observed during the
night. This finding is important because it shows there is no threshold for breathing
pauses that must be exceeded for sleepiness to occur. Sleepiness from sleep apnea is thus
a cumulative phenomenon that increases with apnea frequency. In addition, Dr. Javier Nieto
from SHHS's Johns Hopkins University field center, has submitted a manuscript showing that
there is an association between sleep apnea and hypertension, and Dr. Eyal Shahar from
SHHS's University of Minnesota field center has submitted a paper demonstrating an
association between sleep apnea and self-reported cardiovascular disease. These findings
have been highlighted in several scientific forums throughout the year including a
presentation by yours truly at the annual American Academy of Insurance Medicine meeting
which was held in the "Old Pueblo" this past October. These results have
heightened awareness in the medical community and also among the public that sleep apnea
may be an important risk factor for cardiovascular health. All of us associated with SHHS
believe that further information from our study will help define the importance of sleep
apnea as a health risk more precisely. Thank you for your previous participation in our
study and again we anticipate working with you in the near future.
Dr. Stuart F. Quan
Principal Investigator
Current Happenings
It has been a busy year for the Sleep Heart
Health Study. Here are a few interesting things going on here in Tucson:
1. We received funding to continue with this important research for another five
year period. SHHS2 is currently in the planning stages. We plan to conduct another cycle
of sleep studies and continue the adjudication of cardiovascular events. More information
on SHHS2 will be forthcoming soon.
2. The 1999 Annual Survey is enclosed with this newsletter. Please take a few minutes
now to complete the questionnaire and return in the postage paid envelope. This information
is vitally important to the success of the Sleep Heart Health Study, as it allows us to
compare the sleep apnea score to cardiovascular and other health problems over a long
period of time. Every answer you give is completely confidential, and will only be used for
the general purposes of the study. Thank you in advance for your time in completing this
survey.
3. Follow Up visits have been completed. We completed over 850 out of 900
follow-up visits, a very successful rate. We have gained important information such as
another blood pressure and weight on each of you as well as significant medical histories.
Thank you for your willingness to participate in the follow-up exam.
4. Events adjudication is the process by which we determine whether a participant
has had a cardiovascular event, such as heart attack, congestive heart failure, or stroke.
Again, this information is examined by participant ID only; no names are given in relation
to the health record. Also, this data is kept strictly confidential to only Sleep Heart
Health Study investigators. We have held six adjudication committee meetings and examined
numerous events. The Annual Survey and Follow Up exam are vital to this process. Events
adjudication will continue for at least five more years, hopefully more.
Should you have any questions concerning these or other happenings with SHHS, please
do not hesitate to call us at (520) 626-5001. Thank you for all of your participation thus
far, and please remember to take a few moments to complete the 1999 Annual Survey, and
return it in the self-addressed stamped envelope.
Jamie Goodwin
Program Coordinator
The Association Between Sleep
Disorders & Quality of Life
Our study looked at the relationship between sleep disorders
and quality of life. We studied 5,816 men and women participating in the Sleep Heart
Health Study. Their average age was 63 years. Sleep disorders and quality of life were
measured by means of an overnight sleep study and survey questionnaires. The sleep
disorders included sleep apnea (breathing stops for periods of time while sleeping),
insomnia (trouble falling asleep, staying asleep, and early morning awakening), and
abnormal daytime sleepiness (feeling sleepy or falling asleep while reading, watching TV,
and/or driving). We also looked at differences in men and women with sleep complaints to
see if there are differences in men and women's quality of life.
We found that men had more sleep apnea and reported more abnormal daytime sleepiness
compared to women. Women reported more insomnia. We then looked at the relationship between
these sleep disorders with quality of life. We found that the quality of life of men and
women with sleep apnea is poorer than in men and women without sleep apnea, and as sleep
apnea progressed from mild to severe, quality of life worsened. People with mild to
moderate sleep apnea reported feeling less energetic and more tired. However, people with
severe sleep apnea were not only more tired, they also felt less able to carry out daily
physical activities (such as bathing, dressing, or shopping), reported poorer general health,
and were less able participate in social activities. Men and women with insomnia and abnormal
daytime sleepiness had poorer overall quality of life compared to persons without insomnia or
abnormal daytime sleepiness. In addition to the problems that people with severe sleep
apnea have, people with insomnia and abnormal daytime sleepiness also reported more bodily
pain, had more trouble with work or other activities, and reported mental health problems,
such as depression. The only quality of life difference found between men and women with
sleep disorders was that men with abnormal daytime sleepiness were more likely to complain of
tension, nervousness, or depression.
Carol Baldwin, PhD
Co-Investigator
