Clinical Scorecard: Cardiovascular Risks Associated with Sleep Apnoea: Emphasizing Gender Differences for Targeted Treatment Approaches

At a Glance

Key Highlights

• OSA prevalence is 2-4 times higher in men, but women with OSA have a higher risk of cardiovascular events.
• Women with OSA show greater cardiovascular risk regardless of obesity status.
• Current diagnostic criteria and clinical trials may underrepresent women due to atypical symptoms and reliance on apnoea–hypopnea index.

Guideline-Based Recommendations

Diagnosis

• Consider gender differences in symptom presentation; women may present with atypical symptoms such as insomnia, fatigue, or mood disturbances.
• Use refined diagnostic criteria beyond apnoea–hypopnea index to capture OSA severity in women.

Management

• Recognize the higher cardiovascular risk in women with OSA and tailor treatment accordingly.
• Address comorbid conditions including depression and overall health status in women with OSA.

Monitoring & Follow-up

• Implement cardiovascular risk stratification incorporating gender, genotype, and phenotypic measures.
• Monitor for cardiovascular events such as myocardial infarction, angina, stroke, and heart failure, especially in women.

Risks

• Underdiagnosis and undertreatment of OSA in women due to atypical symptoms and diagnostic biases.
• Potential for worse cardiovascular outcomes in women with OSA linked to endothelial dysfunction and coronary artery calcification.

Patient & Prescribing Data

Large Japanese cohort including men and women with sleep apnoea syndrome

Women with OSA have higher hazard ratios for cardiovascular events compared to men, indicating need for gender-specific treatment approaches.

Clinical Best Practices

• Increase awareness of gender-specific presentations of OSA to reduce diagnostic bias.
• Incorporate mental health assessment in OSA management, particularly in women.
• Design prospective studies to investigate gender-specific cardiovascular risks and pathophysiology in OSA.
• Use comprehensive risk stratification tools beyond AHI to guide treatment decisions.

References

• Gender differences in cardiovascular events among patients with sleep apnoea syndrome: a real-world data analysis