Cardiovascular risk in patients with OSA-COPD (Overlap Syndrome-OVS) from the European Sleep Apnea database (ESADA): the role of Sex

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Introduction: Patients with OVS tend to have worse clinical prognosis compared to patients with COPD or OSA alone. However, the effect of sex on cardiovascular risk remains unclear. Aims and objectives: To assess the influence of sex on prevalence and incidence of cardiovascular disease (CVD) and excessive daytime sleepiness (EDS) in patients with OVS in the ESADA cohort (an ERS based CRC). Methods: We included COPD patients diagnosed with OSA (AHI≥5) and followed up for up to six years. Demographic and PSG data were compared between sexes and multivariable regression analysis was used to investigate the relationship between sex and CVD and EDS while adjusting for age, BMI, smoking, indices of OSA severity and other comorbidities. Results: 666 patients with OVS were included (18% females). Females were more obese (35 vs 33, p=0.014), with less severe OSA (AHI 30 vs 42, ODI 29 vs 40, p<0.001) and higher FEV1 (63 vs 59, p=0.037). Regression analysis indicated no influence of sex on prevalent CVD (p=0.873) and EDS (p=0.796). At follow up (median 1 year, n=349), although no influence of sex was noted on incident CVD (p=0.788), there was a trend towards male sex influencing EDS improvement (β=1.629, p=0.068). The strongest predictor of new CVD was not using PAP [OR: 3.235 (1.1908-0.791), p=0.021)], whereas PAP use was the most important factor for EDS improvement (β=2.398, p=0.035). Conclusions: Our results suggest a potential link between sex and EDS improvement favoring male sex, but not with CVD possibly due to lower number of females. Importantly PAP use played a significant role in EDS improvement and in reducing incidence of CVD.

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