Sleep Disorders Linked to Aortic Stenosis

TOPLINE:

Having any sleep disorder was independently linked to a higher likelihood for developing aortic stenosis, although dyslipidemia appeared to be an important mediator of the risk

METHODOLOGY:

• Researchers analyzed data from the TriNetX network and the All of Us study to examine the association between sleep disorders and the future incidence of aortic stenosis.
• A test cohort used data from 8.8 million patients aged > 50 years with or without sleep disorders. A validation cohort used data from 392,259 participants in the United States, 70,070 of whom had been diagnosed with a sleep disorder.
• Cox proportional hazards models were used to assess the risk for aortic stenosis in patients with sleep disorders, adjusting for hypertension, hyperlipidemia, diabetes, chronic kidney disease, sex at birth, and body mass index.
• The researchers analyzed biochemical data were to explore potential mechanisms, focusing on lipid profiles and the role of lipids in mediating the association between sleep disorders and aortic stenosis.

TAKEAWAY:

• Data from the TriNetX database showed the presence of any sleep disorder was associated with an increased risk for aortic stenosis (hazard ratio [HR], 1.15; 95% CI, 1.13-1.83), with the strongest association observed for sleep apnea (HR, 1.2; 95% CI, 1.17-1.24).
• Similar results were observed for patients in the All of Us cohort, confirming the increased risk for aortic stenosis in those with any sleep disorder (HR, 1.4; 95% CI, 1.12-1.77).
• Although sleep disorders were linked to a smaller proportion of cases of aortic stenosis during the follow-up period (population attributable fraction [PAF], 4.35%) than major risk factors like obesity (PAF, 33.2%), their effect was similar to that of chronic kidney disease (PAF, 4.4%).

IN PRACTICE:

“This statistically significant association was mainly driven by sleep apnea, hypersomnia, narcolepsy, and sleep movement disorders and remained robust when the model was controlled for traditional cardiovascular risk factors, suggesting that sleep disorders independently contribute to the [aortic stenosis] risk profile,” the authors of the study wrote. “We further find that the increased risk is largely associated with a higher prevalence of classical cardiovascular risk factors and particularly dyslipidemia.”

“The application of machine learning to refine and integrate sleep and image derived phenotypes with genetics will elucidate the mechanisms which underlie this apparent relationship,” the researchers added. “Thus, sleep disorders are potential modifiable risk factors” for the development of aortic stenosis. 

SOURCE:

This study was led by Nadim El Jamal, MD, of the University of Pennsylvania Perelman School of Medicine, Philadelphia. It was published online on March 9, 2025, in the American Journal of Preventive Cardiology.

LIMITATIONS:

Potential residual confounding by unmeasured variables could have affected the findings, despite model adjustments for known risk factors for aortic stenosis. The possibility of an overlap in the patients included in the databases may have affected the results.

DISCLOSURES:

This study did not receive any specific funding. One author reported receiving grants from the American Heart Association, and another declared being the Robert L. McNeil Jr Fellow in Translational Medicine and Therapeutics. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.