Obstructive Sleep Apnea Linked to Heart Failure, Death in Women
Sleep apnea has been typically associated with snoring middle-aged men. A recent Harvard study points to information that women that have sleep apnea may experience poorer heart health than men. The findings are the results of the first study to examine the relationship between obstructive sleep apnea (OSA) and cardiovascular death exclusively in women.
The study, published in the medical journal Circulation, calls for future guidelines and policy statements to address changes in screening and care strategies for women. Risk factors for sleep apnea and the development of subsequent cardiovascular (CV) complications differ by sex, but it is not clear from prior research whether the effects of sleep apnea on heart disease is similar for men and women.
OSA, Cardiovascular Disease, and Sex-Based Differences
To evaluate whether sex-based differences exist in the relationship between OSA and CV disease, researchers at Brigham and Women’s Hospital (BWH) evaluated the links among sleep apnea, cardiac bio-markers that provide early evidence of heart disease, and occurrence of adverse heart outcomes in 1,625 individuals who were free of heart disease when first studied, and followed for an average of almost 14 years.
Results of the research found that sex-specific differences exist in the relationship between sleep apnea and CV disease, in women, sleep apnea was associated with higher blood levels of troponin, a chemical signal of early heart damage.
“The finding that sleep apnea is associated with evidence of early heart injury and an elevation in long term risk of heart failure, coronary heart disease, enlargement of the heart muscle, and death in women highlights the importance of sleep apnea screening and treatment for women, a group who often are not routinely screened for sleep apnea,” said co-author Susan Redline, MD, MPH, associate clinical director, in the Division of Sleep and Circadian Disorders at BWH.
The study examined post-menopausal women, who are at a greater risk for sleep apnea and heart disease. Researchers found that older women may be at relatively greater risk of sleep apnea related heart disease compared to men.
At the beginning of the study, when participants were an average age of approximately 63 years, 23 percent of men and 10 percent of women had undiagnosed moderate to severe sleep apnea. Over a 14 year follow up, 46 percent of men and 32 percent of women experienced a significant adverse cardiac event, death, or had an enlarged heart.
Women with moderate to severe sleep apnea were more than 30 percent likely to experience these adverse heart problems compared to women without sleep apnea. This relationship was not statistically significant in men, suggesting that factors such as age, obesity, hypertension and diabetes explained most of the observed heart disease risk in the men studied.
The study echoes the importance of recognizing sleep apnea symptoms in women, particularly in those who are post-menopausal, in whom the incidence of sleep apnea increases.
“We hope these results focus attention on the importance of sleep apnea in women, who historically are under-diagnosed in this area,” Redline noted.
In women, obstructive sleep apnea severity was independently associated with higher left ventricular mass index, whereas in men this association was not significant. In women, but not men, obstructive sleep apnea severity was associated with the combined outcome of incident HF, CHD, death, or left ventricular hypertrophy (LVH). LVH is a condition in which the muscle wall of heart’s left pumping chamber (ventricle) becomes thickened (hypertrophy). Other conditions, such as heart attack, valve disease and dilated cardiomyopathy, can cause the heart (or the heart cavity) to become enlarged.
Examining Signals of Obstructive Sleep Apnea
In sleep apnea, the airway collapses or becomes blocked during sleep. This causes shallow breathing or breathing pauses. When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Sleep apnea is more common in people who are overweight, but it can affect anyone.
People with obstructive sleep apnea are often the last ones to know they have it: After all, it happens while they are asleep… Symptoms of sleep apnea that include snoring, gasping as night, bed partner’s observation of ‘stopping breathing,’ morning headaches, non-refreshing sleep or daytime sleepiness should undergo sleep testing.
CPAP Therapy for OSA
Sleep apnea is a chronic condition that requires long-term management. Lifestyle changes, mouthpieces, surgery, and breathing devices such as continuous positive airway pressure (CPAP) can successfully treat sleep apnea in many people.
CPAP uses mild air pressure through a mask and tubing to keep the airways open. A physician prescribes the appropriate pressure after sleep testing has been performed.
If you are a woman and have been told you snore or stop breathing when you are asleep, and considering these new data regarding OSA and the increased risks for heart problems in women, it is important that you seek medical attention. Ask your physician if a sleep study may be right for you.
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