Sleep-disordered breathing subtypes and future diet quality in the Multi-Ethnic Study of Atherosclerosis

Sleep-disordered breathing (SDB) and diet quality impact cardiometabolic disease, but few studies have examined if SDB influences diet quality. This study estimated the association between SDB subtypes (with and without sleepiness) and future diet quality in the Multi-Ethnic Study of Atherosclerosis.

Probable SDB was characterized by self-reported physician-diagnosed sleep apnea (PDSA) or habitual snoring and subtyped by presence or absence of sleepiness. A food frequency questionnaire measured diet 1.6 years before, and 7.8 years after SDB assessment. Diet quality was measured with the Alternate Healthy Eating Index-2010 (AHEI). Mean differences in AHEI at follow-up by SDB subtypes were estimated with multivariable linear regression adjusting for baseline AHEI, demographic, and lifestyle factors.

Among 3294 participants (mean age 62 years, 51% women), 29.5% had SDB. When grouped by sleepiness, 20.6% had SDB without, and 8.9% had SDB with, sleepiness. Adjusting for baseline diet and potential confounders, those with SDB had lower follow-up AHEI scores compared with unaffected individuals (mean AHEI difference [95% CI]: -1.02 [-1.69, -0.35]). Upon stratifying by sleepiness, both groups had lower AHEI scores at follow-up compared with unaffected individuals, and the difference was greater for those with sleepiness (mean score difference [95% CI]: -0.8 [-1.56, -0.04], without sleepiness; -1.52 [-2.59, -0.45], with sleepiness). The difference between those with and without sleepiness was not statistically significant.

In a multi-ethnic cohort, SDB was associated with lower diet quality after 7.8 years and this association was larger among participants with SDB with sleepiness.