Gender Differences in Cardiovascular Events among Patients with Sleep Apnoea Syndrome: A Real-World Data Analysis of a Nationwide Epidemiological Dataset.

Aim: Sleep apnoea syndrome (SAS) is a common sleep disorder associated with heightened cardiovascular risks, yet sex-specific differences in these risks remain unclear.

Methods: This retrospective observational cohort study utilized the JMDC Claims Database, covering >5 million individuals in Japan. We analyzed data from 4,173,702 individuals (2,406,930 men, 1,766,772 women) after excluding those with central SAS, cardiovascular disease, and incomplete lifestyle questionnaire data. SAS was identified using ICD-10 codes and treatment records. Cox regression models adjusted for multiple factors examined the association between SAS and cardiovascular outcomes.

Results: Among the participants, 39,078 men (1.62%) and 3,960 women (0.22%) were diagnosed with SAS. Over a mean follow-up of 1,290±1,000 days, SAS was associated with an increased risk of composite cardiovascular events, with a hazard ratio (HR) of 1.27 (95% CI, 1.23-1.31) in men and 1.72 (95% CI, 1.54-1.92) in women compared to those without SAS. The association was significantly stronger in women than in men (P-value for interaction< 0.001) and this sex difference was validated by various sensitivity analyses.

Conclusions: Despite the lower prevalence of SAS among women, there was a gender disparity in the cardiovascular impact of SAS, with women demonstrating a significantly higher risk compared to men. This underscores the importance of tailored management strategies aimed at early detection and cardiovascular disease prevention specifically in female patients with SAS.