OSA Is Common and Independently Associated With Hypertension and Increased Arterial Stiffness in Consecutive Perimenopausal Women

Study Questions:

Is obstructive sleep apnea (OSA) common among perimenopausal women, and is it associated with higher blood pressure or arterial stiffness?

Methods:

Women ages 45-65 years were recruited from gynecology clinics from 2011 to 2012. Perimenopause was defined as menstrual irregularity or amenorrhea >60 days. Excluded patients were perimenopausal women with a history of smoking in the past 5 years, heart failure, prior coronary history, stroke, or current use of hormone therapy. None had prior OSA. All patients underwent blood sampling, ambulatory blood pressure monitoring, portable sleep testing, and pulse-wave velocity (PWV), a validated measure of arterial stiffness. Apnea-hypopnea index was defined in a standard fashion.

Results:

A total of 304 consecutive patients were recruited, and after exclusions and agreement to participate, 277 were studied. Study subjects were middle aged (average 56 years [52-61]), overweight women, with body mass index 28 kg/m2 (25-32). The cholesterol levels, renal function, and baseline glucose levels were similar among the two groups. There was no difference in Epworth Sleepiness Scale scores among the two groups. OSA was diagnosed in 111 (40.1%) and moderate to severe OSA in 31 (11.1%) patients. Women with moderate to severe OSA versus those without OSA were treated with more medications for hypertension, had a higher prevalence of hypertension, had higher awake blood pressure (systolic, 133 [125-142] vs. 126 [119-134] mm Hg [p < 0.01]; diastolic, 82 [78-88] vs. 79 [74-85] mm Hg [p = 0.07]), and more arterial stiffness (PWV, 11.5 [10.1-12.3] m/s vs. 9.5 [8.6-10.8] m/s, p < 0.001).

Conclusions:

The authors concluded that OSA is common and underdiagnosed among perimenopausal women. High blood pressure and increased arterial stiffness were independently associated with OSA in this population.

Perspective:

Studies evaluating women for sleep-disordered breathing are typically done among patients referred to sleep clinics. This cross-sectional study represents real-world prevalence of OSA among a group of perimenopausal women without manifest cardiovascular disease. Despite the OSA group being heavier and older (expected), blood pressure and PWV were independently associated with OSA. Practitioners caring for perimenopausal women interested in reducing cardiovascular risk should increase screening and treat women for OSA.

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Lipid Metabolism, Nonstatins, Acute Heart Failure, Hypertension, Smoking, Sleep Apnea

Keywords: Stroke, Overweight, Cross-Sectional Studies, Risk Factors, Smoking, Glucose, Vascular Stiffness, Cholesterol, Body Mass Index, Polysomnography, Middle Aged, Blood Pressure Monitoring, Ambulatory, Heart Failure, Perimenopause, Hypertension, Sleep Apnea, Obstructive


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