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BMJ 2012; 344 doi: (Published 25 January 2012) Cite this as: BMJ 2012;344:e585

Obstructive sleep apnoea linked to cardiovascular death in women

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Men with obstructive sleep apnoea have an increased risk of death from cardiovascular disease, and so do some women, according to an exclusively female cohort from Spain. The authors tracked 1116 women referred to sleep clinics with suspected obstructive sleep apnoea. They reported 41 cardiovascular deaths (3.6%) during a mean follow-up of six years. The 95 women with severe and untreated disease were three times more likely to die of cardiovascular disease than those without obstructive sleep apnoea in fully adjusted analyses (18 deaths in 95 women v 5 deaths in 278 women; hazard ratio 3.5, 95% CI 1.23 to 9.98). Mild or moderate obstructive sleep apnoea was not linked to cardiovascular mortality in this study, and neither was treated obstructive sleep apnoea of any severity.

These findings, although preliminary, suggest that we should be paying as much attention to obstructive sleep apnoea in women as we do in men, say the authors. Between 2% and 3% of middle aged women have the disorder, but it is harder to recognise because symptoms tend to include depression, anxiety, or insomnia rather than the daytime sleepiness and witnessed apnoea seen in men.

Treatment with continuous positive airway pressure (CPAP) may reduce the cardiovascular risk associated with severe obstructive sleep apnoea in women, and confirmatory trials would be ideal, although difficult to perform. It wouldn’t be ethical to withhold CPAP deliberately from women with severe obstructive sleep apnoea, say the authors.

How long is needed between DXA scans for older women?

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US guidelines recommend screening older women for suboptimal bone mineral density using dual energy x ray absorptiometry (DXA). Women with frank osteoporosis can be treated, but how often should we recall the rest?

The goal of screening is to pick up …

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