Background-Clinic-based observational studies in men have reported that obstructive sleep apnea is associated with an increased incidence of coronary heart disease. The objective of this study was to assess the relation of obstructive sleep apnea to incident coronary heart disease and heart failure in a general community sample of adult men and women. Methods and Results-A total of 1927 men and 2495 women Ն40 years of age and free of coronary heart disease and heart failure at the time of baseline polysomnography were followed up for a median of 8.7 years in this prospective longitudinal epidemiological study. After adjustment for multiple risk factors, obstructive sleep apnea was a significant predictor of incident coronary heart disease (myocardial infarction, revascularization procedure, or coronary heart disease death) only in men Յ70 years of age (adjusted hazard ratio 1.10 [95% confidence interval 1.00 to 1.21] per 10-unit increase in apnea-hypopnea index [AHI]) but not in older men or in women of any age. Among men 40 to 70 years old, those with AHI Ն30 were 68% more likely to develop coronary heart disease than those with AHI Ͻ5.Obstructive sleep apnea predicted incident heart failure in men but not in women (adjusted hazard ratio 1.13 [95% confidence interval 1.02 to 1.26] per 10-unit increase in AHI). Men with AHI Ն30 were 58% more likely to develop heart failure than those with AHI Ͻ5. Conclusions-Obstructive sleep apnea is associated with an increased risk of incident heart failure in communitydwelling middle-aged and older men; its association with incident coronary heart disease in this sample is equivocal. (Circulation. 2010;122:352-360.)Key Words: epidemiology Ⅲ sleep apnea Ⅲ coronary disease Ⅲ heart failure O bstructive sleep apnea (OSA), characterized by recurrent partial or complete collapse of the upper airway during sleep, is a common chronic condition that affects an estimated 9% of adult women and 24% of adult men. 1 A number of cross-sectional studies have reported an association of OSA with coronary heart disease (CHD), 2-6 although most were small hospital or clinic-based case-control studies that often lacked adjustment for important cardiovascular risk factors. Recent longitudinal studies have found an association of untreated OSA with incident or recurrent cardiovascular disease events. [7][8][9][10] Because untreated OSA generally reflected refusal or voluntary discontinuance of continuous positive airway pressure (CPAP) therapy, a healthy-user effect might be an important source of confounding bias in these studies. Moreover, women were absent from or underrepresented in these studies. Clinical Perspective on p 360Several cross-sectional studies indicate a high prevalence of OSA of 11% to 37% in patients with heart failure. [11][12][13] One study found echocardiographic evidence of left ventricular diastolic dysfunction in 56% of newly diagnosed OSA patients but in only 20% of control subjects; diastolic dysfunction improved with CPAP therapy. 14 Small clinical trials Continuing me...

U.S. health professionals report not fully performing the 5 A's. The common barriers and facilitators identified may help inform strategies for increasing the involvement of all health professionals in conducting tobacco dependence treatments.