Link between common disorder and cardiovascular conditions exists even in young adults, UTSW study finds
Obstructive sleep apnea (OSA) is linked to an increased risk of cardiovascular disease in adults, even those younger than 40, researchers at UT Southwestern Medical Center found. Their study, published in the Journal of the American Heart Association, demonstrates a strong association between OSA and the development of a wide range of heart-related conditions in adults of all ages.
OSA is a common disorder characterized by recurrent episodes of partial or complete upper airway obstruction during sleep, leading to disrupted breathing patterns and intermittent lack of oxygen. The most significant risk factor for OSA is obesity.
Study leader Bhaskar Thakur, Ph.D., is 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.
“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 study leader Bhaskar Thakur, Ph.D., 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. “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.”
UTSW researchers analyzed data from the National Health and Nutrition Examination Survey conducted between 2013 and 2018, comprising 9,887 adults over the age of 20. Their analysis showed that individuals with self-reported OSA symptoms – snoring, gasping, breath cessation while sleeping, or excessive daytime fatigue – had higher rates of cardiovascular disease such as angina, heart attack, or stroke. They also had associated risk factors including hypertension, diabetes, high cholesterol, or metabolic syndrome (the presence of three or more conditions that increase the risk of heart disease).
Approximately 51% of the study participants had probable OSA. Among those, 36.2% had hypertension, 24.3% had diabetes, 66.1% had high cholesterol, and 48% had metabolic syndrome. Additionally, 8.6% reported having had a cardiovascular event or being diagnosed with heart disease.
The link between probable OSA and an increased prevalence of cardiovascular disease or risk factors was even stronger among individuals in the 20-40 age group than those 41 and above. For example, young adults with OSA had an adjusted prevalence ratio (aPR) of 1.45 for hypertension, indicating they were 1.45 times more likely to have hypertension compared with young adults without OSA. Similarly, the aPR for diabetes was 1.33, and for metabolic syndrome, it was 1.25, showing a significantly higher risk in young adults with OSA. In contrast, older adults with OSA had lower aPRs: 1.10 for hypertension, 1.12 for diabetes, and 1.07 for metabolic syndrome, indicating a less pronounced but still elevated risk compared with older adults without OSA.
Young adults with OSA were also three times more likely to have experienced a cardiovascular event than those without.
“The public tends to think of sleep apnea as simply ‘bad sleep’ that causes fatigue, but the implications are far more serious,” Dr. 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.”
Although the exact nature of the relationship between OSA and cardiovascular disease is not known, UTSW researchers are interested in continuing to study the link, especially among young adults.
“Our goal is to further investigate this relationship and increase the level of understanding and awareness about the risks of OSA,” Dr. Thakur said.
Other UTSW researchers from the Department of Family and Community Medicine who contributed to this study are F. David Schneider, M.D., M.S.P.H., Chair and Professor; Anna Wani, M.D., Assistant Professor; Safia Khan, M.D., Associate Professor (also of Neurology) and Director of the UTSW Sleep Medicine Fellowship Program; Chance Strenth, Ph.D., Instructor; and Rupini Alla, M.D., former resident.
Dr. Schneider holds the Perry E. Gross, M.D. Distinguished Chair in Family Medicine and also serves as Chief of Family and Community Medicine at Texas Health Dallas.