title: 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.
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.
  
  
  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.
authors: From the Divisions of Cardiovascular Medicine (G.Q.R., S.R., B.C., S.D.S., A.M.S.) and Sleep and Circadian Disorders (S.R.), Brigham and Women's Hospital, Boston, MA; Division of Cardiology, Columbia University Medical Center, New York (N.B.); and Division of Pulmonary and Critical Care Medicine; Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.).
authors: Gabriela Querejeta
authors: GQ
authors: Roca
authors: From the Divisions of Cardiovascular Medicine (G.Q.R., S.R., B.C., S.D.S., A.M.S.) and Sleep and Circadian Disorders (S.R.), Brigham and Women's Hospital, Boston, MA; Division of Cardiology, Columbia University Medical Center, New York (N.B.); and Division of Pulmonary and Critical Care Medicine; Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.).
authors: Susan
authors: S
authors: Redline
authors: From the Divisions of Cardiovascular Medicine (G.Q.R., S.R., B.C., S.D.S., A.M.S.) and Sleep and Circadian Disorders (S.R.), Brigham and Women's Hospital, Boston, MA; Division of Cardiology, Columbia University Medical Center, New York (N.B.); and Division of Pulmonary and Critical Care Medicine; Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.).
authors: Brian
authors: B
authors: Claggett
authors: From the Divisions of Cardiovascular Medicine (G.Q.R., S.R., B.C., S.D.S., A.M.S.) and Sleep and Circadian Disorders (S.R.), Brigham and Women's Hospital, Boston, MA; Division of Cardiology, Columbia University Medical Center, New York (N.B.); and Division of Pulmonary and Critical Care Medicine; Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.).
authors: Natalie
authors: N
authors: Bello
authors: From the Divisions of Cardiovascular Medicine (G.Q.R., S.R., B.C., S.D.S., A.M.S.) and Sleep and Circadian Disorders (S.R.), Brigham and Women's Hospital, Boston, MA; Division of Cardiology, Columbia University Medical Center, New York (N.B.); and Division of Pulmonary and Critical Care Medicine; Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.).
authors: Christie M
authors: CM
authors: Ballantyne
authors: From the Divisions of Cardiovascular Medicine (G.Q.R., S.R., B.C., S.D.S., A.M.S.) and Sleep and Circadian Disorders (S.R.), Brigham and Women's Hospital, Boston, MA; Division of Cardiology, Columbia University Medical Center, New York (N.B.); and Division of Pulmonary and Critical Care Medicine; Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.).
authors: Scott D
authors: SD
authors: Solomon
authors: From the Divisions of Cardiovascular Medicine (G.Q.R., S.R., B.C., S.D.S., A.M.S.) and Sleep and Circadian Disorders (S.R.), Brigham and Women's Hospital, Boston, MA; Division of Cardiology, Columbia University Medical Center, New York (N.B.); and Division of Pulmonary and Critical Care Medicine; Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.). ashah11@partners.org.
authors: Amil M
authors: AM
authors: Shah
mesh_terms: D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D015897:Comorbidity; D003327:Coronary Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003644:Death Certificates; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology*; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D017286:Polysomnography; D011446:Prospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D020107:Troponin T / Q000097:blood; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
keywords: echocardiography; heart failure; sex; sleep disorders; troponin T