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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.

TitleSex-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.
Publication TypeJournal Article
Year of Publication2015
AuthorsRoca GQuerejeta, Redline S, Claggett B, Bello N, Ballantyne CM, Solomon SD
Secondary AuthorsShah AM
JournalCirculation
Volume132
Issue14
Pagination1329-37
Date Published2015 Oct 06
ISSN1524-4539
KeywordsAged, Biomarkers, C-Reactive Protein, Comorbidity, Coronary Disease, Death Certificates, Female, Follow-Up Studies, Heart Failure, Hospitalization, Humans, Hypertrophy, Left Ventricular, Hypertrophy, Right Ventricular, Male, Middle Aged, Mortality, Natriuretic Peptide, Brain, Peptide Fragments, Polysomnography, Prospective Studies, Severity of Illness Index, Sex Factors, Sleep Apnea, Obstructive, Troponin T, Ultrasonography, United States
Abstract

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.

DOI10.1161/CIRCULATIONAHA.115.016985
Alternate JournalCirculation
PubMed ID26316620
PubMed Central IDPMC4596785
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
K08 HL116792 / HL / NHLBI NIH HHS / United States
HHSN268201100009I / HL / NHLBI NIH HHS / United States
268201100011C / / PHS HHS / United States
268201100005C / / PHS HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
268201100007C / / PHS HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
U01 HL063463 / HL / NHLBI NIH HHS / United States
HHSN268201100005G / HL / NHLBI NIH HHS / United States
HHSN268201100008I / HL / NHLBI NIH HHS / United States
HC-11-08 / HC / NHLBI NIH HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
268201100012C / / PHS HHS / United States
268201100008C / / PHS HHS / United States
HHSN268201100011I / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
U01HL53934 / HL / NHLBI NIH HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
268 201100009C / / PHS HHS / United States
HHSN268201100005I / HL / NHLBI NIH HHS / United States
U01 HL053934 / HL / NHLBI NIH HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
268201100006C / / PHS HHS / United States
268201100010C / / PHS HHS / United States
HHSN268201100007I / HL / NHLBI NIH HHS / United States
K08-HL-116792 / HL / NHLBI NIH HHS / United States
U01HL53940 / HL / NHLBI NIH HHS / United States
U01HL63463 / HL / NHLBI NIH HHS / United States