Sex Differences in Atherosclerotic Cardiovascular Disease Risk in Obstructive Sleep Apnea.

PURPOSE OF REVIEW: This review outlines obstructive sleep apnea (OSA) associated atherosclerotic cardiovascular disease (ASCVD) risk and highlights emerging data suggestive of sex differences.

RECENT FINDINGS: Females with OSA have greater hypertension risk, higher carotid intima-media thickness, elevated cardiac enzymes, and worse outcomes following ischemic cardiovascular events relative to males with OSA. Mechanistically, this parallels sex differences in nocturnal hypoxemia, immune cell activity, inflammation, and endothelial function which frequently coincide with low estrogen levels. OSA-associated ASCVD risk appears more pronounced in females than males. This could be attributable to sex differences in the etiology of OSA and resultant activation of pathophysiological mechanisms. However, more data are required to differentiate causality from epiphenomena and develop individualized therapies to mitigate ASCVD in patients with OSA.