Obstructive sleep apnea and cardiovascular disease: Role of the metabolic syndrome and its components

Journal of Clinical Sleep Medicine

Volumn 4, Issue 3, 2008, Pages 261-272

  Jean Louis, Girardin ^a,b,c   Zizi, Ferdinand ^a,b,c   Clark, Luther T ^a   Brown, Clinton D ^a   McFarlane, Samy I ^a  

^a SUNY DOWNSTATE MEDICAL CENTER   (United States)

^b SUNY Downstate Medical Center   (United States)

^c Brooklyn Research Foundation on Minority Health   (United States)

Author keywords

Cardiovascular disease; Metabolic syndrome; Sleep apnea

Indexed keywords

AGE DISTRIBUTION; ALCOHOL CONSUMPTION; BLOOD CLOTTING DISORDER; CARDIOVASCULAR DISEASE; CARDIOVASCULAR RISK; DEMOGRAPHY; DIABETES MELLITUS; DISEASE ASSOCIATION; DISEASE SEVERITY; DYSLIPIDEMIA; ENDOTHELIUM LESION; HEART ATRIUM FIBRILLATION; HEART LEFT VENTRICLE FUNCTION; HUMAN; HYPERTENSION; METABOLIC SYNDROME X; OBESITY; OXIDATIVE STRESS; PATHOPHYSIOLOGY; POSITIVE END EXPIRATORY PRESSURE; RACE DIFFERENCE; REVIEW; RISK FACTOR; SEX DIFFERENCE; SLEEP APNEA SYNDROME; SMOKING; SYMPATHETIC TONE; SYSTOLIC BLOOD PRESSURE; THORAX PRESSURE; THROMBOCYTE ACTIVATION;

EID: 47849094262     PISSN: 15509389     EISSN: 15509397     Source Type: Journal    
DOI: 10.5664/jcsm.27191     Document Type: Review

References (137)

1. Partinen M, Guilleminault C. Evolution of obstructive sleep apnea syndrome. In: Partinen M, Guilleminault C, eds. Obstructive sleep apnea syndrome. New York: Raven Press; 1990:15-23.
2. Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400, patients with sleep apnea syndrome. Am J Cardiol 1983;52:490-4.
3. Hoffstein V. Blood pressure, snoring, obesity, and nocturnal hypoxaemia. Lancet 1994;344:643-5.
4. Hoffstein V, Mateika S. Cardiac arrhythmias, snoring, and sleep apnea. Chest 1994;106:466-71.
5. Yaggi HK, Concato J, Kernan WN, et al. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005;353:2034-41.
6. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001;163:19-25.
7. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000;283:1829-36.
8. Aartz M, Young T, Finn L, et al. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 2005;172:1447-51.
9. Pinto JM, Garpestad E, Weiss JW, et al. Hemodynamic changes associated with obstructive sleep apnea followed by arousal in a porcine model. J Appl Physiol 1993;75:1439-43.
10. Somers VK, Dyken ME, Clary MP, et al. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995;96:1897-904.
11. Patil SP, Schneider H, Schwartz AR, et al. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest 2007;132:325-37.
12. Hudgel DW. Mechanisms of obstructive sleep apnea. Chest 1992;101(2):541-549.
13. Narkiewicz K, Montano N, Cogliati C, et al. Altered cardiovascular variability in obstructive sleep apnea. Circulation 1998;98:1071-7.
14. Netzer NC, Hoegel JJ, Loube D, et al. Prevalence of symptoms and risk of sleep apnea in primary care. Chest 2003;124:1406-14.
15. Teculescu D, Benamghar L, Hannhart B, et al. [Habitual snoring. Prevalence and risk factors in a sample of the French male population]. Rev Mal Respir 2007;24(3, Pt 1):281-7.
16. Findley LJ, Weiss JW, Jabour ER. Drivers with untreated sleep apnea. A cause of death and serious injury. Arch Intern Med 1991;151:1451-52.
17. Stoohs RA, Guilleminault C, Itoi A, et al. Traffic accidents in commercial long-haul truck drivers: the influence of sleep-disordered breathing and obesity. Sleep 1994;17:619-23.
18. El Ad B, Lavie P. Effect of sleep apnea on cognition and mood. Int Rev Psychiatry 2005;17:277-82.
19. Sharafkhaneh A, Giray N, Richardson P, et al. Association of psychiatric disorders and sleep apnea in a large cohort. Sleep 2005;28:1405-11.
20. Young T, Finn L. Epidemiological insights into the public health burden of sleep disordered breathing: sex differences in survival among sleep clinic patients. Thorax 1998;53, Suppl 3.S16-9.
21. Omnibus Sleep in America Poll. National Sleep Foundation 2005;1-51.
22. Phillipson EA. Sleep apnea - a major public health problem. N Engl J Med 1993;328:1271-3.
23. The National Commission on Sleep Disorders Research. Wake up America: a national sleep alert. Washington DC: US Government Printing Office 2002.
24. American Heart Association. Heart Disease and Stroke Statistics - 2007, Update. Dallas, TX: American Heart Association 2007;9-17.
25. Coccagna G, Mantovani M, Brignani F, et al. Tracheostomy in hypersomnia with periodic breathing. Bull Physiopathol Respir 1972;8:1217-27.
26. Coccagna G, Mantovani M, Brignani F, et al. Continuous recording of the pulmonary and systemic arterial pressure during sleep in syndromes of hypersomnia with periodic breathing. Bull Physiopathol Respir 1972;8:1159-72.
27. Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annu Rev Med 1976;27:484.
28. Stradling J. Sleep apnea does not cause cardiovascular disease. Am J Respir Crit Care Med 2004;169:148-9.
29. Kiely JL, McNicholas WT, Zgierska A, et al. Cardiovascular risk factors in patients with obstructive sleep apnoea syndrome. Eur Respir J 2000;16:128-33.
30. Somers VK, Gami AS, Olson LJ. Treating sleep apnea in heart failure patients: promises but still no prizes. J Am Coll Cardiol 2005;45:2012-4.
31. Somers VK. Sleep - a new cardiovascular frontier. N Engl J Med 2005;353:2070-73.
32. Mehra R, Benjamin EJ, Shahar E, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 2006;173:910-6.
33. Gami AS, Pressman G, Caples SM. Association of atrial fibrillation and obstructive sleep apnea. Circulation 2004;27:367.
34. Fletcher EC. Cardiovascular disease associated with obstructive sleep apnea. Monaldi Arch Chest Dis 2003;59:254-61.
35. Fletcher EC. Sympathetic over activity in the etiology of hypertension of obstructive sleep apnea. Sleep 2003;26:15-19.
36. Parker JD, Brooks D, Kozar LF, et al. Acute and chronic effects of airway obstruction on canine left ventricular performance. Am J Respir Crit Care Med 1999;160:1888-96.
37. Lavie L, Lotan R, Hochberg I, et al. Haptoglobin polymorphism is a risk factor for cardiovascular disease in patients with obstructive sleep apnea syndrome. Sleep 2003;26(5):592-595.
38. Lavie L. Obstructive sleep apnoea syndrome - an oxidative stress disorder. Sleep Med Rev 2003;7:35-51.
39. Zwillich C, Devlin T, White D, et al. Bradycardia during sleep apnea. Characteristics and mechanism. J Clin Invest 1982;69:1292.
40. Lazarus A, Varin J, Jauvert G, et al. Relationship between cardiac arrhythmias and sleep apnoea in permanently paced patients with type I myotonic dystrophy. Neuromuscul Disord 2007;17:392-9.
41. Shalaby A, Atwood C, Hansen C, et al. Feasibility of automated detection of advanced sleep disordered breathing utilizing an implantable pacemaker ventilation sensor. Pacing Clin Electrophysiol 2006;29:1036-43.
42. Dyken ME, Somers VK, Yamada T, et al. Investigating the relationship between stroke and obstructive sleep apnea. Stroke 1996;27:401-7.
43. Ip MS, Lam B, Chan LY, et al. Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure. Am J Respir Crit Care Med 2000;162:2166-71.
44. Budhiraja R, Parthasarathy S, Quan SF. Endothelial dysfunction in obstructive sleep apnea. J Clin Sleep Med 2007;3:409-15.
45. Kasasbeh E, Chi DS, Krishnaswamy G. Inflammatory aspects of sleep apnea and their cardiovascular consequences. South Med J 2006;99:58-67.
46. Lavie L. Sleep-disordered breathing and cerebrovascular disease: a mechanistic approach. Neurol Clin 2005;23:1059-75.
47. Semenza GL, Prabhakar NR. HIF-1-dependent respiratory, cardiovascular, and redox responses to chronic intermittent hypoxia. Antioxid Redox Signal 2007;9:1391-6.
48. Nanduri J, Nanduri RP. Cellular mechanisms associated with intermittent hypoxia. Essays Biochem 2007;43:91-104.
49. Yokoe T, Minoguchi K, Matsuo H, et al. Elevated levels of C-reactive protein and interleukin-6, in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation 2003;107:1129-34.
50. Brown G, Albers JJ, Fisher LD, et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med 1990;323:1289-98.
51. Fletcher EC. Cardiovascular effects of continuous positive airway pressure in obstructive sleep apnea. Sleep 2000;23, Suppl 4:S154-7.
52. Kaneko Y, Floras JS, Usui K, et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med 2003;348:1233-41.
53. Malone S, Liu PP, Holloway R, et al. Obstructive sleep apnoea in patients with dilated cardiomyopathy: effects of continuous positive airway pressure. Lancet 1991;338:1480-4.
54. Bradley TD, Logan AG, Kimoff RJ, et al. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med 2005;353:2025-33.
55. Somers VK, Dyken ME, Clary MP, et al. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995;96:1897-904.
56. Parish JM, Adam T, Facchiano L. Relationship of metabolic syndrome and obstructive sleep apnea. J Clin Sleep Med 2007;3:467-72.
57. Kylin E. Studien uber das Hypertonie-Hyperglykamie-Hyperurikamiesyndrome. Zentralblatt für innere Medizin 1923;44:127.
58. Wilcox I, McNamara SG, Collins FL, et al. «Syndrome Z»: the interaction of sleep apnoea, vascular risk factors and heart disease. Thorax 1998;53, Suppl 3:S25-8.
59. Zimmet P, Magliano D, Matsuzawa Y, et al. The metabolic syndrome: a global public health problem and a new definition. J Atheroscler Thromb 2005;12:295-300.
60. Grundy SM. Metabolic syndrome scientific statement by the American Heart Association and the National Heart, Lung, and Blood Institute. Arterioscler Thromb Vasc Biol 2005;25:2243-4.
61. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Curr Opin Cardiol 2006;21:1-6.
62. Grundy SM. Metabolic syndrome: therapeutic considerations. Handb Exp Pharmacol 2005:107-33.
63. Grundy SM. A constellation of complications: the metabolic syndrome. Clin Cornerstone 2005;7:36-45.
64. Alexander CM. The coming of age of the metabolic syndrome. Diabetes Care 2003;26:3180-1.
65. Reaven G. The metabolic syndrome or the insulin resistance syndrome? Different names, different concepts, and different goals. Endocrinol Metab Clin North Am 2004;33:283-303.
66. Reaven G, Abbasi F, McLaughlin T. Obesity, insulin resistance, and cardiovascular disease. Recent Prog Horm Res 2004;59:207-23.
67. Reaven GM. Insulin resistance, cardiovascular disease, and the metabolic syndrome: how well do the emperor's clothes fit? Diabetes Care 2004;27:1011-2.
68. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002;287:356-9.
69. Ford ES. Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S. Diabetes Care 2005;28:2745-9.
70. Alberti KG. The costs of non-insulin-dependent diabetes mellitus. Diabet Med 1997;14:7-9.
71. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-52.
72. Reilly DF, Westgate EJ, FitzGerald GA. Peripheral circadian clocks in the vasculature. Arterioscler Thromb Vasc Biol 2007;27:1694-1705.
73. Ivanov PC, Hu K, Hilton MF, et al. Endogenous circadian rhythm in human motor activity uncoupled from circadian influences on cardiac dynamics. Proc Natl Acad Sci U S A 2007;104:20702-7.
74. Tofler GH, Brezinski D, Schafer AI, et al. Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med 1987;316:1514-8.
75. Kario K, Pickering TG, Matsuo T, et al. Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives. Hypertension 2001;38:852-7.
76. Kario K, Shimada K, Pickering TG. Abnormal nocturnal blood pressure falls in elderly hypertension: clinical significance and determinants. J Cardiovasc Pharmacol 2003;41(Suppl 1):S61-6.
77. Wilcox I, Grunstein RR, Collins FL, et al. Circadian rhythm of blood pressure in patients with obstructive sleep apnea. Blood Press 1992;1:219-22.
78. Bravo ML, Serpero LD, Barcelo A, et al. Inflammatory proteins in patients with obstructive sleep apnea with and without daytime sleepiness. Sleep Breath 2007;11:177-85.
79. Vgontzas AN, Chrousos GP. Sleep, the hypothalamic-pituitary-adrenal axis, and cytokines: multiple interactions and disturbances in sleep disorders. Endocrinol Metab Clin North Am 2002;31:15-36.
80. Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab 2000;85:1151-8.
81. National Center for Health Statistics Health, United States 2006;1-543.
82. Kumanyika SK, Gary TL, Lancaster KJ, et al. Achieving healthy weight in African-American communities: research perspectives and priorities. Obes Res 2005;13:2037-47.
83. Grunstein R, Wilcox I, Yang TS, et al. Snoring and sleep apnoea in men: association with central obesity and hypertension. Int J Obes Relat Metab Disord 1993;17:533-40.
84. Kushida CA, Efron B, Guilleminault C. A predictive morphometric model for the obstructive sleep apnea syndrome. Ann Intern Med 1997;127(8, Pt 1):581-7.
85. Punjabi NM, Sorkin JD, Katzel LI, et al. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 2002;165:677-82.
86. Peppard PE, Young T, Palta M, et al. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284:3015-21.
87. Coughlin SS, Calle EE, Teras LR, et al. Diabetes mellitus as a predictor of cancer mortality in a large cohort of US adults. Am J Epidemiol 2004;159:1160-7.
88. Coughlin SR, Mawdsley L, Mugarza JA, et al. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 2004;25:735-41.
89. Makinodan K, Yoshikawa M, Fukuoka A, et al. Effect of serum leptin levels on hypercapnic ventilatory response in obstructive sleep apnea. Respiration 2008;75:257-64.
90. Ancoli-Israel S, Klauber MR, Stepnowsky C, et al. Sleep-disordered breathing in African-American elderly. J Gerontol 1989;44:M18-21.
91. Redline S, Tishler P, Hans M, et al. Racial differences in sleep-disordered breathing in African-Americans and Caucasians. Am J Respir Crit Care Med 1997;155:186-92.
92. Palmer LJ, Buxbaum SG, Larkin EK, et al. Whole genome scan for obstructive sleep apnea and obesity in African-American families. Am J Respir Crit Care Med 2004;169(12):1314-1321.
93. Young T, Peppard P, Palta M, et al. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 1997;157:1746-52.
94. Fletcher EC. The relationship between systemic hypertension and obstructive sleep apnea: facts and theory. Am J Med 1995;98:118-28.
95. Mayer J, Becker H, Brandenburg U, et al. Blood pressure and sleep apnea: results of long-term nasal continuous positive airway pressure therapy. Cardiology 1991;79:84-92.
96. Hoffstein V, Chan CK, Slutsky AS. Sleep apnea and systemic hypertension: a causal association review. Am J Med 1991;91:190-6.
97. Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ 2000;320:479-82.
98. Ohayon MM, Guilleminault C, Priest RG, et al. Is sleep-disordered breathing an independent risk factor for hypertension in the general population (13, 057 subjects)? J Psychosom Res 2000;48:593-601.
99. Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378-84.
100. Harris MI. Diabetes in America: epidemiology and scope of the problem. Diabetes Care 1998;(21,Suppl 3):C11-4.
101. Kitabchi AE, Temprosa M, Knowler WC, et al. Role of insulin secretion and sensitivity in the evolution of type 2, diabetes in the diabetes prevention program: effects of lifestyle intervention and metformin. Diabetes 2005;54:2404-14.
102. Ip MS, Lam B, Ng MM, et al. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 2002;165:670-6.
103. Punjabi NM, Shahar E, Redline S, et al. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol 2004;160:521-30.
104. Punjabi NM, Polotsky VY. Disorders of glucose metabolism in sleep apnea. J Appl Physiol 2005;99:1998-2007.
105. Spiegel R, Knudtson K, Leproult R., et al. Sleep loss: a novel risk factor for insulin resistance and Type II diabetes. J Appl Physiol 2005;99:2008-19.
106. Punjabi NM, Ahmed MM, Polotsky VY, et al. Sleep-disordered breathing, glucose intolerance, and insulin resistance. Respir Physiol Neurobiol 2003;136(2-3):167-178.
107. Ayas NT, White DP, Manson JE, et al. A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med 2003;163:205-9.
108. Ayas NT, White DP, Al Delaimy WK, et al. A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care 2003;26:380-4.
109. Gottlieb DJ, Punjabi NM, Newman AB, et al. Association of sleep time with diabetes mellitus and impaired glucose tolerance. Arch Intern Med 2005;165:863-7.
110. Sanders MH, Givelber R. Sleep disordered breathing may not be an independent risk factor for diabetes, but diabetes may contribute to the occurrence of periodic breathing in sleep. Sleep Med 2003;4:349-50.
111. Jean-Louis G, Kripke DF, Ancoli-Israel S, et al. Sleep duration, illumination, and activity patterns in a population sample: effects of gender and ethnicity. Biol Psychiatry 2000;47:921-7.
112. Patel SR, Ayas NT, Malhotra MR, et al. A prospective study of sleep duration and mortality risk in women. Sleep 2004;27:440-4.
113. Jean-Louis G, Kripke DF, Ancoli-Israel S. Sleep and quality of well-being. Sleep 2000;23:1115-21.
114. Kripke DF, Simons RN, Garfinkel L, et al. Short and long sleep and sleeping pills. Is increased mortality associated? Arch Gen Psychiatry 1979;36:103-16.
115. Kripke DF, Garfinkel L, Wingard DL, et al. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry 2002;59:131-6.
116. Harsch IA, Hahn EG, Konturek PC. Insulin resistance and other metabolic aspects of the obstructive sleep apnea syndrome. Med Sci Monit 2005;11:RA70-5.
117. Coughlin SR, Mawdsley L, Mugarza JA, et al. Cardiovascular and metabolic effects of CPAP in obese males with OSA. Eur Respir J 2007;29:720-7.
118. Stamler J, Wentworth D, Neaton JD. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222, primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA 1986;256:2823-8.
119. Goff DC, Jr., Bertoni AG, Kramer H, et al. Dyslipidemia prevalence, treatment, and control in the Multi-Ethnic Study of Atherosclerosis (MESA): gender, ethnicity, and coronary artery calcium. Circulation 2006;113:647-56.
120. O'Meara JG, Kardia SL, Armon JJ, et al. Ethnic and sex differences in the prevalence, treatment, and control of dyslipidemia among hypertensive adults in the GENOA study. Arch Intern Med 2004;164:1313-8.
121. Kiely JL, McNicholas WT. Cardiovascular risk factors in patients with obstructive sleep apnoea syndrome. Eur Respir J 2000;16:128-33.
122. Zgierska A, Gorecka D, Radzikowska M, et al. Obstructive sleep apnea and risk factors for coronary artery disease. Pneumonol Alergol Pol 2000;68:238-46.
123. Tan KC, Chow WS, Lam JC, et al. HDL dysfunction in obstructive sleep apnea. Atherosclerosis 2006;184:377-82.
124. Borgel J, Sanner BM, Bittlinsky A, et al. Obstructive sleep apnoea and its therapy influence high-density lipoprotein cholesterol serum levels. Eur Respir J 2006;27:121-7.
125. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.
126. Lee PY, Yun AJ, Bazar KA. Acute coronary syndromes and heart failure may reflect maladaptations of trauma physiology that was shaped during pre-modern evolution. Med Hypotheses 2004;62:861-7.
127. Mansfield DR, Gollogly NC, Kaye DM, et al. Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med 2004;169:361-6.
128. Milleron O, Pilliere R, Foucher A, et al. Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. Eur Heart J 2004;25:728-34.
129. Avenell A, Broom J, Brown TJ, et al. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess 2004;8:iii-182.
130. Thoolen B, De Ridder D, Bensing J, et al. The effectiveness of a self-management intervention in patients with screen-detected type-2, diabetes. Diabetes Care 2007;30:2832-7.
131. Erdman DM, Cook CB, Greenlund KJ, et al. The impact of outpatient diabetes management on serum lipids in urban African-Americans with type 2 diabetes. Diabetes Care 2002;25:9-15.
132. Okuda N, Ito T, Emura N, et al. Depressed myocardial contractile reserve in patients with obstructive sleep apnea assessed by tissue Doppler imaging with dobutamine stress echocardiography. Chest 2007;131:1082-9.
133. Penn NE, Kar S, Kramer J, et al. Ethnic minorities, health care systems, and behavior. Health Psychol 1995;14:641-6.
134. Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev 2000;57, Suppl 1:108-45.
135. McBean AM, Gornick M. Differences by race in the rates of procedures performed in hospitals for Medicare beneficiaries. Health Care Financ Rev 1994;15:77-90.
136. Meetze K, Gillespie MB, Lee FS. Obstructive sleep apnea: a comparison of black and white subjects. Laryngoscope 2002;112(7, Pt 1):1271-4.
137. Lackland DT, Lin Y, Tilley BC, et al. An assessment of racial differences in clinical practices for hypertension at primary care sites for medically underserved patients. J Clin Hypertens 2004;6:26-31.