Sex differences in the association between obstructive sleep apnea and hypertension—what’s next?

We thank the editor for inviting both editorials on our recent publication in Chest and we also thank Freitas et al. and Fuchs et al. and appreciate their interest in our work (1). As the readership of Journal of Thoracic Disease is aware, most of the evidence on the cardiovascular impact of obstructive sleep apnea (OSA) comes from studies with a small proportion of women. However, over the last decade some studies have assessed the sex-related impact of OSA on cardiovascular outcomes, especially hypertension, with conflicting results (2-5). Along this line, we evaluated the relationship between OSA and incident hypertension in a previous analysis of the Vitoria Sleep Cohort and we did not find an independent association in men or in women (6). Subsequently, we performed a post hoc analysis to explore the relationship between OSA and incident stage 2 hypertension (blood pressure ≥160/100 mmHg) and we found an association in men but not in women.