Cardiovascular Disease Rate is Greater in Younger Than Older Adults with OSA

Bhaskar Thakur, PhD

Credit: UT Southwestern, Pinto Lab

Young adults aged 20 – 40 years with obstructive sleep apnea (OSA) have greater cardiovascular disease (CVD) rates than adults with OSA who are > 40 years old, a new study found.¹

This finding contradicts the belief that older adults are more likely to have a CVD risk. Older adults in the general population may be more likely to develop CVD, but young adults also have a risk. In the case of OSA, younger adults have a greater CVD risk.

“Our research highlights the need for OSA screening in primary care settings, especially for younger adults who can benefit the most from early intervention,” said lead investigator, Bhaskar Thakur, PhD, assistant professor of Family and Community Medicine, Emergency Medicine, Physical Medicine & Rehabilitation, and in the Peter O’Donnell Jr. School of Public Health at UT Southwestern, in a statement.² “Discussion of sleep quality and a review of OSA symptoms should be a regular part of every adult patient’s annual physical, regardless of age.”

Strong evidence exists on the association between OSA and cardiovascular risks.¹ A study revealed metabolic scores were positively associated with OSA severity. Research has shown OSA elevates blood pressure, low-density lipoprotein cholesterol, and triglycerides.

Studies have also suggested OSA is associated with heart failure. Despite OSA’s relationship with CVD, this sleep disorder is often an overlooked risk factor when treating CVD.

Little is known about the implications of OSA on cardiovascular health in younger adults. People often view CVD as a disease that occurs later in life, but young adults have CVD risk factors, too. Investigators sought to examine the prevalence of probable OSA and its relationship with cardiovascular risks and diseases in young (20 – 40 years) versus older (> 40 years) adults in the US.

The team conducted a study with a cross-sectional design and leveraged data from the National Health and Nutrition Examination Survey with 9887 community-dwelling adults aged ≥ 20 years from 2013–2014, 2015–2016, and 2017–2018. Participants had a mean age of 47.6 years and an average body mass index of 29.6. Approximately half were women (52%) and most were non-Hispanic White (63.6%), followed by Hispanic (15.5%), non‐Hispanic Black (10.9%), non‐Hispanic Asian (5.8%), and non‐Hispanic multiracial (4.1%).

Probable OSA was determined by self-reported OSA-related symptoms, such as snoring and gasping/breath cessation while sleeping. Cardiovascular risk factors, including hypertension, diabetes, hyperlipidemia, and metabolic syndrome, were evaluated based on established guidelines. Cardiovascular diseases were self-reported heart conditions, such as congestive heart failure, coronary heart disease, angina, heart attacks, and strokes.

Approximately 51% of the participants had probable OSA. Among these individuals, 36.2% had hypertension, 24.3% had diabetes, 66.1% had high cholesterol, 48% had metabolic syndrome, and 8.6% reported having a cardiovascular event or being diagnosed with heart disease.

Participants with probable OSA had a significantly greater prevalence of hypertension (adjusted prevalence ratio [aPR], 1.19; P < .001), diabetes (aPR, 1.17l; P = .01), metabolic syndrome (aPR, 1.14; P < .001), heart attack (aPR, 1.63; P < .01), stroke (aPR, 1.41; P = .03), and any CVD event (aPR, 1.36; P = .01). Compared to young adults without OSA, young adults with OSA were 1.45 times more likely to have hypertension (aPR, 1.45; P <.001), 1.25 times more likely to have metabolic syndrome (aPR, 1.25; P < .001), and 3 times more likely to experience any type of CVD event (aPR, 3.44; P < .001). Older adults had lower aPRs for hypertension (1.10), diabetes (1.12), and metabolic syndrome (1.07).

Additionally, young adults with OSA were 10 times more likely to have angina compared to young adults without OSA (aPR, 10.39; P < .001).

Limitations the team highlighted included having no data on clinical diagnoses of OSA, probable OSA only screened through questionnaires, the sample being majorly White participants despite OSA being more prevalent in the Black population, and the prevalence of congestive heart failure, coronary heart disease, and other heart disease in the young adult being low, about ≤ 1%, which could have impacted the findings.

“The public tends to think of sleep apnea as simply ‘bad sleep’ that causes fatigue, but the implications are far more serious,” Thakur said. “With obesity on the rise, the number of young adults with OSA is increasing, and without proper intervention, they are putting themselves at higher risk for a broad range of diseases and conditions. Our goal is to further investigate this relationship and increase the level of understanding and awareness about the risks of OSA.”

References

1. ^{Strenth C, Wani A, Alla R, Khan S, Schneider FD, Thakur B. Obstructive Sleep Apnea and Its Cardiac Implications in the United States: An Age-Stratified Analysis Between Young and Older Adults. J Am Heart Assoc. 2024;13(12):e033810. doi:10.1161/JAHA.123.033810}
2. ^{Sleep Apnea Sufferers More Likely To Develop Heart Disease. News Wise. July 9, 2024. https://www.newswise.com/articles/sleep-apnea-sufferers-more-likely-to-develop-heart-disease. Accessed July 18, 2024.}