Table 3.
Crude and Adjusted Risk Ratios* for Incident Hypertension and Metabolic Syndrome† at 2- to 7-Year Follow-up according to Apnea–Hypopnea Index‡ in Early Pregnancy and Midpregnancy
| AHI Characteristic | n/N (%) | Crude Risk Ratios |
Adjusted Risk Ratios |
||
|---|---|---|---|---|---|
| Estimate (95% CI) | P Value | Estimate (95% CI) | P Value | ||
| Incident hypertension | |||||
| Early pregnancy or midpregnancy | |||||
| AHI < 5 in both early pregnancy and midpregnancy (referent) | 67/1,215 (5.5) | 1.00 | 0.0402 | 1.00 | 0.3344 |
| AHI ⩾ 5 in early pregnancy or midpregnancy | 14/118 (11.9) | 2.15 (1.25–3.71) | 1.39 (0.75–2.56) | ||
| Early pregnancy | |||||
| AHI < 5 (referent) | 96/1,647 (5.8) | 1.00 | 0.0463 | 1.00 | 0.6015 |
| AHI ⩾ 5 | 10/68 (14.7) | 2.52 (1.38–4.62) | 1.21 (0.61–2.41) | ||
| AHI = 0 (referent) | 18/391 (4.6) | 1.00 | 0.1280 | 1.00 | 0.9606 |
| 0 < AHI < 5 | 78/1,256 (6.2) | 1.35 (0.82–2.22) | Trend tests: | 1.03 (0.63–1.68) | Trend tests: |
| 5 ⩽ AHI < 15 | 9/63 (14.3) | 3.10 (1.46–6.60) | 0.3931 linear | 1.26 (0.55–2.88) | 0.8631 linear |
| AHI ⩾ 15 | 1/5 (20.0) | 4.34 (0.71–26.55) | 0.9702 quadratic | 1.11 (0.19–6.61) | 0.8672 quadratic |
| Midpregnancy | |||||
| AHI < 5 (referent) | 72/1,308 (5.5) | 1.00 | 0.0070 | 1.00 | 0.0908 |
| AHI ⩾ 5 | 17/114 (14.9) | 2.71 (1.66–4.43) | 1.73 (0.99–3.01) | ||
| AHI = 0 (referent) | 9/189 (4.8) | 1.00 | 0.0547 | 1.00 | 0.3871 |
| 0 < AHI < 5 | 63/1,119 (5.6) | 1.18 (0.60–2.34) | Trend tests: | 0.86 (0.44–1.69) | Trend tests: |
| 5 ⩽ AHI < 15 | 14/100 (14.0) | 2.94 (1.32–6.55) | 0.1325 linear | 1.43 (0.62–3.30) | 0.3511 linear |
| AHI ⩾ 15 | 3/14 (21.4) | 4.50 (1.37–14.77) | 0.7140 quadratic | 1.92 (0.49–7.60) | 0.5638 quadratic |
| Metabolic syndrome | |||||
| Early pregnancy or midpregnancy | |||||
| AHI < 5 in both early pregnancy and midpregnancy (referent) | 165/1,200 (13.8) | 1.00 | <0.0001 | 1.00 | 0.0211 |
| AHI ⩾ 5 in early pregnancy or midpregnancy | 48/124 (38.7) | 2.82 (2.16–3.66) | 1.44 (1.08–1.93) | ||
| Early pregnancy | |||||
| AHI < 5 (referent) | 260/1,630 (16.0) | 1.00 | <0.0001 | 1.00 | 0.1214 |
| AHI ⩾ 5 | 32/69 (46.4) | 2.91 (2.20–3.84) | 1.28 (0.95–1.73) | ||
| AHI = 0 (referent) | 43/383 (11.2) | 1.00 | <0.0001 | 1.00 | 0.4454 |
| 0 < AHI < 5 | 217/1,247 (17.4) | 1.55 (1.14–2.11) | Trend tests: | 1.07 (0.80–1.43) | Trend tests: |
| 5 ⩽ AHI < 15 | 29/63 (46.0) | 4.10 (2.78–6.05) | 0.1141 linear | 1.38 (0.92–2.07) | 0.5643 linear |
| AHI ⩾ 15 | 3/6 (50.0) | 4.45 (1.91–10.40) | 0.4084 quadratic | 1.25 (0.50–3.13) | 0.7232 quadratic |
| Midpregnancy | |||||
| AHI < 5 (referent) | 178/1,292 (13.8) | 1.00 | <0.0001 | 1.00 | 0.0754 |
| AHI ⩾5 | 45/121 (37.2) | 2.70 (2.06–3.53) | 1.33 (0.99–1.79) | ||
| AHI = 0 (referent) | 13/189 (6.9) | 1.00 | <0.0001 | 1.00 | 0.1497 |
| 0 < AHI < 5 | 165/1,103 (15.0) | 2.17 (1.26–3.74) | Trend tests: | 1.31 (0.78–2.21) | Trend tests: |
| 5 ⩽ AHI < 15 | 37/107 (34.6) | 5.03 (2.80–9.03) | 0.0053 linear | 1.64 (0.91–2.97) | 0.0432 linear |
| AHI ⩾15 | 8/14 (57.1) | 8.31 (4.15–16.62) | 0.4603 quadratic | 2.32 (1.11–4.86) | 0.8503 quadratic |
Definition of abbreviations: AHI = apnea–hypopnea index; BMI = body mass index; CI = confidence interval; HDL-C = high-density lipoprotein cholesterol; HHS = Heart Healthy Study.
Poisson regression models are used for the analyses with robust error covariance used to compute CIs and to test for trends. P values are based on likelihood ratio tests. Analyses are adjusted for age and BMI (linear and quadratic) in early pregnancy, race, and time from delivery to HHS cardiovascular assessment.
Metabolic syndrome is defined based on the presence of three of five of the following criteria: elevated waist circumference, elevated triglycerides or associated medication, elevated fasting glucose or associated medication, elevated blood pressure or associated medication, and reduced HDL-C or associated medication. Analyses are adjusted for age and BMI in early pregnancy, race, and time from delivery to HHS cardiovascular assessment.
Including all apneas and hypopneas with ⩾3% oxygen desaturation per hour.