Cardiovascular Risks in Sleep Apnoea: Gender Differences and Treatment Implications

Overview

Obstructive sleep apnoea (OSA) significantly increases cardiovascular risk, with women exhibiting a higher risk of events such as myocardial infarction and heart failure compared to men. This gender disparity persists regardless of obesity status and highlights the need for gender-specific diagnostic and treatment approaches.

Background

OSA is a common disorder characterized by repeated upper airway obstruction during sleep, leading to intermittent hypoxia and sympathetic activation. It affects nearly 1 billion people worldwide, with men being diagnosed more frequently than women. OSA is strongly linked to cardiovascular diseases including hypertension, stroke, and heart failure. However, current treatments like continuous positive airway pressure have inconclusive effects on cardiovascular outcomes, underscoring the need for improved risk stratification that considers gender differences.

Data Highlights

Key Findings

• Women with OSA have a significantly higher risk of cardiovascular events (HR 1.72) compared to men (HR 1.27).
• This increased risk in women is consistent across both obese and non-obese individuals.
• Women often present with atypical OSA symptoms, such as insomnia and mood disturbances, leading to underdiagnosis.
• Apnoea–hypopnea index may underestimate OSA severity in women due to milder hypopneas and prolonged partial obstructions.
• Potential mechanisms for higher cardiovascular risk in women include greater endothelial dysfunction and coronary artery calcification.
• The interplay between OSA, depression, and cardiovascular disease may further worsen outcomes in women.

Clinical Implications

Clinicians should be aware of the higher cardiovascular risk in women with OSA and consider gender-specific symptom profiles during diagnosis. Reliance solely on apnoea–hypopnea index may miss significant disease burden in women, necessitating more comprehensive assessment tools. Tailored treatment strategies that address both cardiovascular and mental health aspects in women with OSA are essential to improve outcomes.

Conclusion

Gender differences significantly influence cardiovascular risks associated with OSA, with women facing disproportionately higher risks. Future research and clinical practice must incorporate these differences to optimize diagnosis, risk stratification, and treatment.

References

1. Ko et al. 2023 -- Gender differences in cardiovascular events among patients with sleep apnoea syndrome