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OSA Update

Emerging risks for women with sleep apnea

With 4 months yet to go, 2014 has already provided new and substantial understanding about emerging risks for women related to obstructive sleep apnea (OSA).
In June, findings from University of Michigan-led research, published in the British Journal of Obstetrics and Gynecology, revealed the importance of testing pregnant women with habitual snoring for OSA. The study, led by Louise O'Brien, PhD, MS, an associate professor at the University of Michigan's Sleep Disorders Center, noted that one in two hypertensive pregnant women who habitually snore may have unrecognized OSA. Moreover, one in four hypertensive women who do not exhibit the hallmark snoring of OSA do indeed have the sleeping disorder.

"We know that habitual snoring is linked with poor pregnancy outcomes for mother and child," said O'Brien, "including increased risk of C-sections and smaller babies. . Habitual snoring [shown to increase during pregnancy] may be one of the most telling signs to identify this risk early in order to improve outcomes. . Prompt recognition, evaluation and management will not only improve health benefits for both moms and babies but may also help cut the high healthcare expenses of operative deliveries, taking care of babies who are admitted to the NICU and other associated health risks."

O'Brien's earlier research has shown that women who begin snoring during pregnancy are at a strong risk for high blood pressure and preeclampsia. Since OSA is treatable during pregnancy, O'Brien suggested prompt evaluation, particularly if a hypertensive pregnant woman snores three nights per week or more.

Osteoporosis Risk
Another study shed light on a correlation between OSA and a heightened osteoporosis risk, specifically among women and older adults. Published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism, research from Chi Mei Medical Center in Taiwan revealed the findings after researchers tracked 1,377 people diagnosed with OSA between 2000 and 2008.

From 2008 to 2014, the investigators then examined and compared the rate of osteoporosis diagnosis in the OSA group to the rate of osteoporosis in more than 20,000 patients comparable in age and gender without OSA. They found that patients with OSA were 2.7 times more likely to experience osteoporosis than the group of non-OSA individuals, after adjusting for age, gender, medical problems, environment and income.
Lead investigator Kai-Jen Tien, MD, wrote, "When sleep apnea periodically deprives the body of oxygen, it can weaken bones and raise the risk of osteoporosis. . We need to pay more attention to the relationship between sleep apnea and bone health so we can identify strategies to prevent osteoporosis." The investigator also made the point that the undermining of the skeletal system brought on by OSA can lead to ". bone fractures, increased medical costs, reduced quality of life and even death."

OSA-Stroke Link
Suzie Bertisch, MD, MPH, of Beth Israel Deaconess Medical Center, Boston, is the lead investigator of a recent study co-conducted by researchers at Brigham and Women's Hospital and Harvard Medical School, both of Boston, and Johns Hopkins University, Baltimore. The investigation examined the OSA-stroke relationship in women; findings were presented in May at the American Thoracic Society International Conference 2014, San Diego.

According to the investigators, healthcare has long underestimated the OSA-stroke link in women, considering it more a risk for men.

"Some researchers and clinicians have theorized that because men may have had OSA for longer periods of their lives compared to women, studies have been looking at populations with very different exposure time and that the gender differences that have been apparent in past studies really just reflect inadequate follow-up times," said Bertisch.

To gain some clarity around the issue, the investigators re-examined data from more than 5,400 participants of the Sleep Heart Health Study to determine associations between OSA and stroke. The participants had been given a baseline PSG in the mid-90s and were followed up to 15.8 years.

According to information provided by the investigators to ATS, patients' apnea levels were divided into quartiles using the sleep apnea hypopnea index, where level I represents the lowest severity of apnea and level IV represents the highest. After analyzing data from the cohort, the researchers found - and expected -- a significant association between OAHI quartile and the occurrence of stroke, with greater stroke risk associated with OSA. However they were surprised to find that "the risk of stroke was equal among male and female study participants, a finding which suggests that women are just as susceptible as men when it comes to the vascular effects of OSA," reported ATS.

"Our results could have a substantial impact on our thinking of the risks associated with sleep apnea in women," Bertisch said. "From a clinical standpoint, the results could help clinicians provide more proactive treatment for reducing cardiovascular risk in their female OSA patients."

Understanding about the impact of OSA on women has grown substantially in the first half of 2014. As research continues through this year and beyond, the knowledge base is sure to expand and deliver one predictable endpoint: better patient outcomes.

Valerie Neff Newitt is on staff at ADVANCE. Contact:

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