Age and sex-based differences in cardiovascular disease associated with obstructive sleep apnea: a nationwide inpatient analysis

Obstructive sleep apnea (OSA) is a risk factor for cardiovascular disease (CVD), although its association may differ by type of CVD outcomes according to age and sex. We evaluated the association between a coded diagnosis of OSA and multiple coexisting CVD outcomes in the overall sample and across age and sex. We conducted a retrospective cross-sectional study using the 2017 National Inpatient Sample database by including all adult hospitalizations and excluding other sleep apnea cases. The unit of analysis was hospitalization, and the analyses evaluated associations rather than causation. The primary outcomes were major adverse cardiovascular events (MACE), defined as a composite of cross-sectional events of in-hospital myocardial infarction (MI), heart failure (HF), and ischemic stroke. Secondary outcomes included MI, HF, stroke, coronary heart disease (CHD), atrial fibrillation (AF), and other arrhythmias. Survey-weighted logistic regressions were performed to estimate the adjusted odds ratios (OR) with 95% confidence intervals (CIs). Among 5,997,425 hospitalizations, 412,903 (6.9%) records had OSA. The majority of hospitalizations were in records with patients aged ≥ 40 (75.7%), female (57.9%), and of White race (64.8%). We observed 20.5% MACE, 21.0% CHD, 16.7% HF, 14.6% AF, 3.6% MI, and 2.2% stroke. OSA was associated with MACE (OR = 2.96; 95%CI: 2.82, 3.11, p < 0.001), HF (OR = 3.64; 95%CI: 3.47, 3.83, p < 0.001), MI (OR = 1.23; 95%CI: 1.08, 1.41, p = 0.002), CHD (OR = 1.62; 95%CI: 1.48, 1.78, p < 0.001), and AF (OR = 2.49; 95%CI: 2.28, 2.73, p < 0.001) in age < 40 to a greater extent than MACE (OR = 1.72; 95%CI: 1.69, 1.74, p < 0.001), HF (OR = 1.97; 95%CI: 1.93, 2.00, p < 0.001), MI (OR = 1.04; 95%CI: 1.02, 1.06, p < 0.001), CHD (OR = 1.49; 95%CI: 1.47, 1.52, p < 0.001), and AF (OR = 1.60; 95%CI: 1.58, 1.62, p < 0.001) in age ≥ 40. The extent of association between OSA and CVD events varied by sex, particularly in those aged < 40. OSA was associated with major cardiovascular events across all age groups and in both sexes, with stronger associations observed in younger individuals. These findings highlight the importance of timely diagnosis and appropriate management of OSA and coexisting cardiovascular conditions. However, these findings require validation in prospective longitudinal studies. Not applicable.