Gender differences in cardiovascular events among patients with sleep apnoea syndrome: a real-world data analysis of a nationwide epidemiological dataset.

Abstract

Aims: Sleep apnoea syndrome (SAS) is a common sleep disorder associated with heightened cardiovascular risks, yet sex-specific differences in these risks remain unclear.

Methods and results: This retrospective observational cohort study utilized the JMDC Claims Database, covering >5 million individuals in Japan. We analysed data from 4 173 702 individuals (2 406 930 men and 1 766 772 women) after excluding those with central SAS, cardiovascular disease (CVD), and incomplete lifestyle questionnaire data. Sleep apnoea syndrome was identified using International Classification of Diseases, 10th revision codes and treatment records. Cox regression models adjusted for multiple factors examined the association between SAS and cardiovascular outcomes. Among the participants, 39 078 men (1.62%) and 3960 women (0.22%) were diagnosed with SAS. Over a mean follow-up of 1290 ± 1000 days, SAS was associated with an increased risk of composite cardiovascular events, with a hazard ratio of 1.27 [95% confidence interval (CI), 1.23-1.31] in men and 1.72 (95% CI, 1.54-1.92) in women compared with those without SAS. The association was significantly stronger in women than in men (P-value for interaction < 0.001), and this sex difference was validated by various sensitivity analyses.

Conclusion: Despite the lower prevalence of SAS among women, there was a gender disparity in the cardiovascular impact of SAS, with women demonstrating a significantly higher risk compared with men. This underscores the importance of tailored management strategies aimed at early detection and CVD prevention specifically in female patients with SAS.