Gender, Sleep Apnea, and Cardiac Biomarkers

Study Questions:

What is the relationship between gender, sleep apnea severity, and cardiac biomarker in predicting heart failure (HF) or left ventricular (LV) hypertrophy?


Patients were recruited from participants in both the Sleep Heart Health Study and Atherosclerosis Risk in Communities study. All were free of heart disease at baseline and were followed with visits approximately every 3 years. Exclusions included known obstructive sleep apnea (OSA), treatment of OSA, or use of home oxygen. All patients underwent standard in-laboratory sleep study, high-sensitivity troponin T (hs-TnT), and an echocardiogram after the fifth visit for LV function and mass. Incident HF was defined as occurrence of hospitalization for HF, and incident coronary heart disease was defined as definite or probable myocardial infarction (MI), adjudicated by medical records. Mortality was confirmed by death certificates.


A total of 752 men and 893 women were followed for 13.6 ± 3.2 years. Average age was 62.5 ± 5.5 years and average body mass index (BMI) was 28.6 ± 5.5 kg/m2. In men, more severe OSA was associated with age, higher BMI, higher blood pressure, and presence of lung disease. In women with severe OSA, these same associations among the men were noted plus higher prevalence of diabetes, hypertension, and current smoking in women.


The authors concluded that greater OSA severity is more strongly associated with higher hs-TnT levels in women compared to men even after accounting for potential cofounders. Second, after >13 years of follow-up, OSA severity was associated with incident HF in women, but not in men. Last, OSA diagnosed in mid-life was independently associated with hypertrophy in women, but not in men.


The risks for OSA and heart disease are different for men and women. Controversy over the impact of sex on relationship between OSA severity and cardiovascular outcomes is in part related to which cohort is studied and how greatly the subjects vary in age. In this community-based cohort of middle-aged individuals without heart disease, a biomarker of heart disease, incident HF, and hypertrophy was prospectively identified more in women compared to men. These findings suggest that greater attention to screening of women for OSA may help to reduce their risk of developing heart disease.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Echocardiography/Ultrasound, Hypertension, Smoking, Sleep Apnea

Keywords: Biological Markers, Blood Pressure, Body Mass Index, Diabetes Mellitus, Echocardiography, Heart Failure, Hypertension, Hypertrophy, Left Ventricular, Lung Diseases, Myocardial Infarction, Sleep Apnea, Obstructive, Smoking, Troponin T

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