Patrick Koo1, Umama Gorsi2, JoAnn E Manson3, Matthew A Allison4, Michael J LaMonte5, Mary B Roberts6, Aladdin Shadyab4, Charles B Eaton6,7,8. 1. University of Tennessee College of Medicine, Chattanooga, Department of Respiratory, Critical Care, and Sleep Medicine, Chattanooga, Tennessee. 2. UHS Wilson Medical Center, Department of Cardiovascular Disease, Johnson City, New York. 3. Harvard Medical School, Department of Epidemiology, Brigham and Women's Hospital, Department of Medicine, Boston, Massachusetts. 4. University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, California. 5. University at Buffalo Department of Epidemiology and Environmental Health, Buffalo, New York. 6. Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island. 7. Warren Alpert School of Medicine of Brown University, Department of Family Medicine, Providence, Rhode Island. 8. Brown University School of Public Health, Department of Epidemiology, Providence, Rhode Island.
Abstract
STUDY OBJECTIVES: The relationship between obstructive sleep apnea (OSA) and heart failure (HF) incidence in postmenopausal women has been understudied, given the limited representation of women in heart failure studies. We investigated the relationship between OSA risk factors and HF and its subtypes in postmenopausal women. METHODS: We performed a prospective analysis on the adjudicated HF outcomes in the Women's Health Initiative from enrollment (1993-1998) to September 30, 2016. HF with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF) were defined as adjudicated acute HF hospitalization with EF ≥ 45% or < 45%, respectively. We employed Cox regression to examine the association between OSA risk factors and symptoms (individually and using a summary risk score) and time to first hospitalized HF. RESULTS: Of 42,362 women, 2,205 (5.21%) developed all HF, 1,162 (2.74%) women developed HFpEF, and 679 (1.60%) developed HFrEF. Individual OSA risk factors and symptoms, including obesity (hazard ratio = 1.33, 95% confidence interval [CI] 1.20-1.48), snoring (hazard ratio = 1.30, 95% CI 1.16-1.46), and hypertension (HR = 1.45, 95% CI 1.35-1.56), were positively associated with risk of HF and HFpEF, but only hypertension was associated with HFrEF. When examined as a summary risk score compared with those with none of the OSA risk factors, presence of each additional factor was significantly associated with increased risk of hospitalized HF in a dose-response fashion for HFpEF (P trend < .001), but not HFrEF (P trend = .26). CONCLUSIONS: OSA risk factors and symptoms were associated with HFpEF, but not HFrEF, among postmenopausal women and are largely dependent on body mass index, snoring, and hypertension.
STUDY OBJECTIVES: The relationship between obstructive sleep apnea (OSA) and heart failure (HF) incidence in postmenopausal women has been understudied, given the limited representation of women in heart failure studies. We investigated the relationship between OSA risk factors and HF and its subtypes in postmenopausal women. METHODS: We performed a prospective analysis on the adjudicated HF outcomes in the Women's Health Initiative from enrollment (1993-1998) to September 30, 2016. HF with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF) were defined as adjudicated acute HF hospitalization with EF ≥ 45% or < 45%, respectively. We employed Cox regression to examine the association between OSA risk factors and symptoms (individually and using a summary risk score) and time to first hospitalized HF. RESULTS: Of 42,362 women, 2,205 (5.21%) developed all HF, 1,162 (2.74%) women developed HFpEF, and 679 (1.60%) developed HFrEF. Individual OSA risk factors and symptoms, including obesity (hazard ratio = 1.33, 95% confidence interval [CI] 1.20-1.48), snoring (hazard ratio = 1.30, 95% CI 1.16-1.46), and hypertension (HR = 1.45, 95% CI 1.35-1.56), were positively associated with risk of HF and HFpEF, but only hypertension was associated with HFrEF. When examined as a summary risk score compared with those with none of the OSA risk factors, presence of each additional factor was significantly associated with increased risk of hospitalized HF in a dose-response fashion for HFpEF (P trend < .001), but not HFrEF (P trend = .26). CONCLUSIONS:OSA risk factors and symptoms were associated with HFpEF, but not HFrEF, among postmenopausal women and are largely dependent on body mass index, snoring, and hypertension.
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