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Heart Disease vs Sleep Apnea in Women

Posted Feb 03 2012 3:01am
The first Friday of every February is designated National Wear Red Day to focus our attention on heart disease.  The National Institutes of Health via its National Heart, Lung & Blood Institute started the Heart Truth with its Red Dress campaign a decade ago to especially focus on heart disease in women.  Incredible as it may seem, heart disease is the number one killer of women , 4x more than those who died of stroke, 4x more than those who died of lung cancer, and 7-8x more than those who died of breast cancer.   

Along those lines, I serendipitously stumbled upon a prospective, observational cohort study published in the Annals of Internal Medicine just last month in which the authors followed 1,116 women who had undergone a diagnostic sleep study (yes, ladies, some of you snore!).  Those who had an apnea-hypopnea index (AHI) of less than 10 were deemed normal and served as controls.  Those with an AHI of 10-29 were classified as mild-moderate while those w/AHI greater than or equal to 30 were diagnosed as severe sleep apnea.  AHI is a standardized measure of how many times in an hour one has an apneic or hypopneic event.

Currently, the gold standard for treatment of sleep apnea, regardless of sex, is continuous positive airway pressure (CPAP) , which conjures up images of a loud, obnoxious octopus-like mask that really isn't sexy or romantic, although in reality, the newest devices & masks are much more tolerable.  Adherence to CPAP was deemed usage of at least 4 hours nightly; non-adherence was either less than 4 hours use or no use at all.
Granted, the average age of these women were in their mid-50s, with average body mass index diagnostic for obesity.  Yet, those women with sleep apnea, regardless of severity, had a greater cardiovascular mortality over 6 years than their non-apneic controls.  Likewise, those women with sleep apnea who were adherent to their CPAP had lower cardiovascular mortality compared to those who were not adherent.  
The bottom line is this:  what's good/bad for the gander is also good/bad for the goose.  We've known for quite some time now that sleep apnea increases risk of heart disease in men.  This study demonstrates a similar association in women.  Moreover, we also now have evidence for the protective effect of adequate CPAP use (at least 4 hours nightly) in reducing heart disease.  Go wear some red today and tell the women in your lives.  

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