Sex-Specific Association of Sleep Apnea Severity With Subclinical Myocardial Injury, Ventricular Hypertrophy, and Heart Failure Risk in a Community-Dwelling Cohort: The Atherosclerosis Risk in Communities–Sleep Heart Health Study
Open accessAbstract
Background—: Risk factors for obstructive sleep apnea (OSA) and the development of subsequent cardiovascular (CV) complications differ by sex. We hypothesize that the relationship between OSA and high-sensitivity troponin T (hs-TnT), cardiac structure, and CV outcomes differs by sex. Methods and Results—: Seven hundred fifty-two men and 893 women free of CV disease participating in both the Atherosclerosis Risk in the Communities and the Sleep Heart Health Studies were included. All participants (mean age, 62.5±5.5 years) underwent polysomnography and measurement of hs-TnT. OSA severity was defined by using established clinical categories. Subjects were followed for 13.6±3.2 years for incident coronary disease, heart failure, and CV and all-cause mortality. Surviving subjects underwent echocardiography after 15.2±0.8 years. OSA was independently associated with hs-TnT among women ( P =0.03) but not in men ( P =0.94). Similarly, OSA was associated with incident heart failure or death in women ( P =0.01) but not men ( P =0.10). This association was no longer significant after adjusting for hs-TnT ( P =0.09). Among surviving participants without an incident CV event, OSA assessed in midlife was independently associated with higher left ventricle mass index only among women ( P =0.001). Conclusions—: Sex-specific differences exist in the relationship between OSA and CV disease. OSA, assessed in midlife, is independently associated with higher levels of concomitantly measured hs-TnT among women but not men, in whom other comorbidities associated with OSA may play a more important role. During 13-year follow-up, OSA was associated with incident heart failure or death only among women, and, among those without an incident event, it was independently associated with left ventricular hypertrophy only in women.
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With aging, women may experience increased rates of death and incident heart failure.
“but with aging, may experience increased rates of death and incident heart failure (HF).19”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [19]
The Results (page unavailable) report that, over 13.6 years, greater obstructive sleep apnea severity was associated with the combined outcome of incident heart failure or death in women. The paper does not establish that aging itself increases those rates, and it reports the two outcomes as a composite rather than demonstrating an increase in each separately. (LLM, conf=0.85)
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- Authors
- Roca, G. Q., Redline, S., Claggett, B., Bello, N., Ballantyne, C. M., Solomon, S. D., & Shah, A. M.
- Affiliations
- Brigham and Women's Hospital (US)
- ORCID
- Venue
- Circulation
- Published
- 2015-10-06
- Volume
- 132
- Issue
- 14
- Pages
- 1329-1337
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC4596785
- OpenAlex
- W1924202687
- Semantic Scholar
- 21744cd91b1ab942883c2c397e892a87e8c0f355
- Cited by
- 182
- References
- 41
- Citations by year
- 2026: 17 · 2025: 13 · 2024: 15 · 2023: 15 · 2022: 26 · 2021: 22 · 2020: 11 · 2019: 15 · 2018: 15 · 2017: 9 · 2016: 22 · 2015: 2
- FWCI
- 11.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5u01hl053940-05, 5u01hl053934-14)
- U.S. Public Health Service (268201100007C, 2682011 00008C, 268201100010C, 268201100011C, 268201100012C, 268201100005C, 268201100009C, 268201100006C)
- National Heart, Lung, and Blood Institute (U01 HL 53940, HHSN268201 100012C, HHSN268201100007I, HHSN268201100007C, HHSN2682 01100008C, HH-SN-268201100006C, HHSN268201100011C, HHSN2682011-00005I, U01 HL53934, HHSN2682011-00009I, HHSN268201100005C, HHSN268201100005G, HHSN268201100010C, HC-11-08, HHSN268201100011I, HHSN26820 1100009C, K08HL116792, HHSN2682011-00008I, U01HL063463, U01-HL-053934, U01HL63463)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- obstructive sleep apnea, sex differences, subclinical myocardial injury, high-sensitivity troponin T, left ventricular hypertrophy, heart failure, cardiovascular mortality, coronary disease, community-dwelling adults, midlife, Atherosclerosis Risk in Communities Study, Sleep Heart Health Study
- MeSH terms
- Aged, C-Reactive Protein, Coronary Disease, Death Certificates, Female, Follow-Up Studies, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Mortality, Peptide Fragments, Prospective Studies, Severity of Illness Index, Sex Factors, Ultrasonography, United States, Biomarkers, Comorbidity, Polysomnography, Hypertrophy, Left Ventricular, Hypertrophy, Right Ventricular, Natriuretic Peptide, Brain, Troponin T, Sleep Apnea, Obstructive
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