Real-world data from nearly 30,000 adults suggest single-night assessments may underestimate cardiovascular risks associated with sleep-disordered breathing.
Key takeaways:
- A multi-night study of nearly 30,000 adults found that longer snoring duration and night-to-night variability in sleep apnea severity are associated with increased arterial stiffness.
- The findings suggest that relying on single-night measurements may fail to capture the natural fluctuations of sleep apnea, potentially underestimating a patient’s cardiovascular risk.
- Researchers note that vascular damage associated with obstructive sleep apnea may be partially reversible, as CPAP therapy has been shown to reduce aortic pulse wave velocity.
A large international real-world study published in npj Digital Medicine suggests that the cardiovascular implications of sleep-disordered breathing may be underestimated when assessed on a single night only. Among nearly 30,000 adults monitored over four years, both longer snoring duration and greater night-to-night variability in obstructive sleep apnea (OSA) severity were associated with increased arterial stiffness.
The analysis, conducted by a research team from Flinders University in Adelaide, Australia, evaluated data from 29,653 adults across 20 countries. Participants used two digital health devices in their home environment for an average of four years. Sleep-related breathing disturbances were measured using the Withings Sleep Analyzer, while vascular health was assessed using the Withings Body Cardio scale, which measures aortic pulse wave velocity—a marker of arterial stiffness and a recognized predictor of cardiovascular morbidity and mortality.
Previous research investigating the relationship between OSA and aortic pulse wave velocity has yielded inconsistent results. According to the researchers, one reason is that most studies rely on single-night measurements that fail to capture the night-to-night variability of OSA.
The combination of both devices enabled the analysis of millions of individual measurements collected over several years. This allowed researchers to investigate not only average OSA burden but also the variability of the apnea-hypopnea index (AHI) and the extent of snoring in relation to vascular changes, independent of age, sex, and body mass index (BMI).
“This study shows for the first time in a large real-world dataset that assessing a single night of sleep is not sufficient when evaluating vascular health risks,” says paper co-author Pierre Escourrou, cardiologist and sleep specialist, in a release. “Individuals with highly variable sleep apnea from night to night or frequent snoring carry an independent vascular risk—even if their average AHI appears relatively normal.”
The findings highlight the need to move beyond single-night AHI measurements in diagnostic settings. In particular, patients with mild OSA, high night-to-night variability, or pronounced snoring may have previously underestimated cardiovascular risks.
There is also encouraging evidence regarding treatment. CPAP therapy has been shown to reduce pulse wave velocity, suggesting that vascular damage associated with OSA may be at least partially reversible. Lifestyle interventions have also been shown to improve arterial stiffness.
The study authors advocate incorporating multi-night monitoring into diagnostic pathways and using pulse wave velocity measurement via smart home devices as a monitoring tool for cardiovascular risk in patients with sleep-related breathing disorders.
The study is based on self-selected users of connected health devices, and the cohort was predominantly male, which may limit generalizability. While the consumer devices used are validated, sleep apnea and snoring metrics were not independently confirmed with polysomnography within this specific study, and information on comorbidities or CPAP use was not available.
