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Cardiovascular consequences of obstructive sleep apnea in women: a historical cohort study.

ABSTRACT: OBJECTIVE/BACKGROUND:Evidence on sex differences in the association between obstructive sleep apnea (OSA) and cardiovascular outcomes is limited and controversial. We conducted a historical cohort study to investigate this relationship. PATIENTS/METHODS:Clinical data on adults who underwent sleep study at a large urban academic hospital (Toronto, Canada) between 1994 and 2010 were linked to provincial health administrative data from 1991 to 2015. We fit Cox regressions to investigate the association between OSA severity and a cardiovascular composite outcome (all-cause mortality or hospitalization due to myocardial infarction, stroke, heart failure or atrial fibrillation), controlling for risk factors and stratifying by sex. RESULTS:A total of 10,149 subjects were included: median age of 49 years, 38% women. Over a median of 9.3 years, 1782 (18%) participants developed an outcome. The association between percentage of sleep time spent with oxygen saturation <90% and outcome was stronger for women (HR for IQR, 3 vs 0% = 1.30, 1.19-1.42) than for men (HR for IQR = 1.13, 1.06-1.21) (p for interaction = 0.01) in the adjusted model. Stratifying by sex, oxygen desaturations and heart rate in sleep were significant predictors in both men and women, while presence of daytime sleepiness, sleep efficiency and periodic leg movements in sleep were predictive in women but not in men. CONCLUSIONS:In a large clinical cohort with suspected OSA, the impact of OSA as measured by the degree of nocturnal oxygen desaturation on the composite outcome was found to be greater in women than in men. We also found a different predictive ability of OSA-related factors by sex.

SUBMITTER: Kendzerska T

PROVIDER: S-EPMC7075717 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Cardiovascular consequences of obstructive sleep apnea in women: a historical cohort study.

Kendzerska Tetyana T Leung Richard S RS Atzema Clare L CL Chandy George G Meteb Moussa M Malhotra Atul A Hawker Gillian A GA Gershon Andrea S AS

Sleep medicine 20190911

<h4>Objective/background</h4>Evidence on sex differences in the association between obstructive sleep apnea (OSA) and cardiovascular outcomes is limited and controversial. We conducted a historical cohort study to investigate this relationship.<h4>Patients/methods</h4>Clinical data on adults who underwent sleep study at a large urban academic hospital (Toronto, Canada) between 1994 and 2010 were linked to provincial health administrative data from 1991 to 2015. We fit Cox regressions to investig ...[more]

PMID: 32028229

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Project description:BackgroundObstructive sleep apnea (OSA) has been reported to be a risk factor for cardiovascular (CV) disease. Although the apnea-hypopnea index (AHI) is the most commonly used measure of OSA, other less well studied OSA-related variables may be more pathophysiologically relevant and offer better prediction. The objective of this study was to evaluate the relationship between OSA-related variables and risk of CV events.Methods and findingsA historical cohort study was conducted using clinical database and health administrative data. Adults referred for suspected OSA who underwent diagnostic polysomnography at the sleep laboratory at St Michael's Hospital (Toronto, Canada) between 1994 and 2010 were followed through provincial health administrative data (Ontario, Canada) until May 2011 to examine the occurrence of a composite outcome (myocardial infarction, stroke, congestive heart failure, revascularization procedures, or death from any cause). Cox regression models were used to investigate the association between baseline OSA-related variables and composite outcome controlling for traditional risk factors. The results were expressed as hazard ratios (HRs) and 95% CIs; for continuous variables, HRs compare the 75th and 25th percentiles. Over a median follow-up of 68 months, 1,172 (11.5%) of 10,149 participants experienced our composite outcome. In a fully adjusted model, other than AHI OSA-related variables were significant independent predictors: time spent with oxygen saturation <90% (9 minutes versus 0; HR?=?1.50, 95% CI 1.25-1.79), sleep time (4.9 versus 6.4 hours; HR?=?1.20, 95% CI 1.12-1.27), awakenings (35 versus 18; HR?=?1.06, 95% CI 1.02-1.10), periodic leg movements (13 versus 0/hour; HR?=?1.05, 95% CI 1.03-1.07), heart rate (70 versus 56 beats per minute [bpm]; HR?=?1.28, 95% CI 1.19-1.37), and daytime sleepiness (HR?=?1.13, 95% CI 1.01-1.28).The main study limitation was lack of information about continuous positive airway pressure (CPAP) adherence.ConclusionOSA-related factors other than AHI were shown as important predictors of composite CV outcome and should be considered in future studies and clinical practice.

Dataset Information

Cardiovascular consequences of obstructive sleep apnea in women: a historical cohort study.

Publications

Cardiovascular consequences of obstructive sleep apnea in women: a historical cohort study.

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