TERM: SHHS (Sleep Heart Health Study)



The Sleep Heart Health Study is a multi-center cohort study that has been implemented by the National Heart, Lung, and Blood Institute to determine cardiovascular and other consequences of sleep-disordered breathing. It was a Multi-site prospective cohort study to investigate Obstructive Sleep Apnea (OSA) and other Sleep-disordered Breathing (SBD) as risk factors for cardiovascular diseases and hypertension. The study was motivated by the increasing recognition of the frequent occurrence of sleep-disordered breathing in the general population and mounting evidence that sleep-disordered breathing may increase risk for cardiovascular diseases, including coronary artery disease and stroke, and for hypertension and may reduce quality of life generally. Many clinical questions remain unanswered concerning sleep-disordered breathing as well: for example, we lack insight as to the point in the natural history of the disorder when intervention is warranted; and, while effective treatments for some forms of sleep-disordered breathing have been developed, information is still needed on who is at risk from sleep-disordered breathing so that these treatments can be applied in a cost-effective manner


Participants were recruited from nine existing epidemiological studies in which data on cardiovascular risk factors had been collected previously. The “parent” cohorts include:
  • The Framingham Offspring Cohort
  • The Hagerstown and Minneapolis/St. Paul sites of the Atherosclerosis Risk in Communities (ARIC) study
  • The Hagerstown, Sacramento and Pittsburgh sites of the Cardiovascular Health Study (CHS)
  • The Strong Heart Study sites in South Dakota, Oklahoma, and Arizona
  • Studies of respiratory disease in Tucson and of hypertension in New Yor

The Sleep Heart Health Study will add in-home polysomnography to the data collected in each of the parent studies. Using the Compumedics PS polysomnograph, a single over-night polysomnogram was obtained at home for approximately 6,400 persons; the montage includes oximetry, heart rate, chest wall and abdominal movement, nasal/oral airflow, body position, EEG, EOG, and chin EMG. In-home monitoring can now be conducted feasibly, and this montage provides data on the occurrence of sleep-disordered breathing and on arousals. The sleep data was collected during the second and third years of the initial five-year funding of the Sleep Heart Health Study, and more sleep data will be continuously collected in the seventh and eighth years. All participants will be at least 40 years of age and all minority members of each of the parent cohorts will be recruited. Individuals younger than age 65 years will be selected with stratification by history of snoring, as assessed by a standardized questionnaire to be administered to all members of the parent cohorts; the sampling fraction for snorers will be greater than for non-snorers in order to increase the prevalence of sleep-disordered breathing. For persons older than age 65 years, snoring history does not predict the presence of sleep-disordered breathing and participants will be selected without reference to snoring history. Although the Sleep Heart Health Study is a prospective study, the cross-sectional findings will provide new information on patterns of sleep and sleep-disordered breathing in the general population. The polysomnograms were placed in the homes of the participants by trained certified professionals. The tests recorded montages that consisted of:

  • C3/A2 and C4/A1 EEGs, sampled at 125 hz
  • Right and left electrooculograms (EOGs), sampled at 50 hz
  • A bipolar submental electromyogram (EMG), sampled at 125 hz
  • Thoraic and abdominal excursions (THOR and ABDO), recorded by inductive plethysmography bands and sampled at 10 hz
  • "Airflow" detected by a nasal-oral thermocouple (Protec Woodinville, WA), sampled at 10 hz
  • Finger-tip pulse oximetry (Nonin, Minneapolis, MN) sampled at 1 hz
  • ECG from a bipolar lead, sampled at 125 Hz for most SHHS-1 studies and 250 Hz for SHHS-2 sudies
  • Heart rate (PR) derived from the ECG and sampled at 1Hz
  • Body position (using a mercury gauge sensor)
  • Ambient light (on/off, by a light sensor secured to the recording garmet)

The chart above represents a five-second excerpt of record 0000 from the SHHS database. All data is accessible on the SHHS website.

The study population consisted of:
  • Atherosclerosis Risk in Communities Study (ARIC) - 1,750 participants
  • Cardiovascular Health Study (CHS) - 1,350 participants
  • Framingham Heart Study (FHS) - 1,000 participants
  • Strong Heart Study (SHS) - 600 participants
  • New York Hypertension Cohorts - 1,000 participants
  • Tucson Epidemiologic Study of Airways Obstructive Diseases and the Health and Environment Study - 900 participants

Related Terminology:
Sleep Apnea
Lung Diseases
Cardiovascular Diseases
Heart Diseases
Obstructive Sleep Apnea
National Heart, Lung, and Blood Institute (NHLBI)
Coronary Disease
Myocardial Infraction


Web Resources:




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