The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; ICES, Toronto, Ottawa, Ontario, Canada.
St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Sleep Med. 2020 Apr;68:71-79. doi: 10.1016/j.sleep.2019.08.021. Epub 2019 Sep 11.
OBJECTIVE/BACKGROUND: Evidence on sex differences in the association between obstructive sleep apnea (OSA) and cardiovascular outcomes is limited and controversial. We conducted a historical cohort study to investigate this relationship.
PATIENTS/METHODS: Clinical data on adults who underwent sleep study at a large urban academic hospital (Toronto, Canada) between 1994 and 2010 were linked to provincial health administrative data from 1991 to 2015. We fit Cox regressions to investigate the association between OSA severity and a cardiovascular composite outcome (all-cause mortality or hospitalization due to myocardial infarction, stroke, heart failure or atrial fibrillation), controlling for risk factors and stratifying by sex.
A total of 10,149 subjects were included: median age of 49 years, 38% women. Over a median of 9.3 years, 1782 (18%) participants developed an outcome. The association between percentage of sleep time spent with oxygen saturation <90% and outcome was stronger for women (HR for IQR, 3 vs 0% = 1.30, 1.19-1.42) than for men (HR for IQR = 1.13, 1.06-1.21) (p for interaction = 0.01) in the adjusted model. Stratifying by sex, oxygen desaturations and heart rate in sleep were significant predictors in both men and women, while presence of daytime sleepiness, sleep efficiency and periodic leg movements in sleep were predictive in women but not in men.
In a large clinical cohort with suspected OSA, the impact of OSA as measured by the degree of nocturnal oxygen desaturation on the composite outcome was found to be greater in women than in men. We also found a different predictive ability of OSA-related factors by sex.
目的/背景：阻塞性睡眠呼吸暂停（OSA）与心血管结局之间的性别差异的证据有限且存在争议。我们进行了一项历史队列研究来调查这种关系。
患者/方法：将 1994 年至 2010 年间在加拿大多伦多市一家大型城市学术医院进行睡眠研究的成年人的临床数据与 1991 年至 2015 年的省级健康行政数据进行了关联。我们使用 Cox 回归来研究 OSA 严重程度与心血管复合结局（全因死亡率或因心肌梗死、中风、心力衰竭或心房颤动住院）之间的关联，同时控制了危险因素并按性别分层。
共纳入 10149 名受试者：中位年龄为 49 岁，38%为女性。在中位时间为 9.3 年的随访中，1782 名（18%）参与者发生了结局事件。与男性（HR 为 IQR，3%对 0%=1.13，1.06-1.21）相比，女性（HR 为 IQR，3%对 0%=1.30，1.19-1.42）中，睡眠期间血氧饱和度<90%的时间百分比与结局的关联更强（调整模型中的交互作用 p 值=0.01）。按性别分层，睡眠中的氧减饱和度和心率在男性和女性中都是显著的预测因素，而日间嗜睡、睡眠效率和睡眠中的周期性肢体运动在女性中是预测因素，但在男性中不是。
在一个有疑似 OSA 的大型临床队列中，我们发现夜间氧减饱和度程度衡量的 OSA 对复合结局的影响在女性中比在男性中更大。我们还发现，OSA 相关因素的预测能力在性别上存在差异。
