# The association between obstructive sleep apnea risk and cardiovascular disease risk in midlife Thai women in the U.S

## TL;DR

This study finds that obstructive sleep apnea risk is linked to higher cardiovascular disease risk in midlife Thai women in the U.S., with sleep quality and cultural factors playing a role.

## Contribution

The study identifies OSA risk as a novel predictor of CVD risk in midlife Thai immigrant women, highlighting the mediating and moderating roles of sleep and sociocultural factors.

## Key findings

- OSA risk was independently associated with higher calculated CVD risk.
- Sleep quality and OSA risk partially mediated the effects of sociodemographic factors on CVD risk.
- Sleep quality moderated the effects of education and employment on CVD risk.

## Abstract

This study examined associations between self-reported sleep characteristics (quality, efficiency, and obstructive sleep apnea [OSA] risk), sociodemographic and cultural factors, and calculated cardiovascular disease (CVD) risk among Thai women across menopausal stages in the United States. We also evaluated whether sleep characteristics mediated or moderated these relationships.

In this cross-sectional study, participants completed questionnaires assessing sleep, OSA risk, and sociodemographic factors. Weight, height, and blood pressure were measured to calculate 10-year CVD risk. Analyses included bivariate correlations, robust regression, and structural equation modeling to test mediation and moderation.

Among 120 participants (mean [SD] age 51.53 years [7.73]; mean calculated-CVD risk score 6.56 [5.74]), 17% had high calculated CVD risk. Length of U.S. stay was positively associated with CVD risk (r = 0.40, p < 0.001), whereas education and number of children were negatively associated (r=–0.22, p = 0.016; r=–0.32, p < 0.001). OSA risk was independently associated with higher CVD risk (B = 5.514, p < 0.001). Self-reported sleep quality, sleep efficiency, and OSA risk partially mediated the effects of length of stay in the U.S., number of children, employment, and anxiety on CVD risk. Sleep quality moderated the effects of education and employment on CVD risk, while OSA risk moderated the effects of education, anxiety, and menopausal symptoms.

Self-reported OSA risk was significantly associated with higher calculated CVD risk. These findings suggest that subjective sleep disturbances, particularly OSA risk, may contribute to cardiovascular vulnerability among midlife Thai immigrant women. Longitudinal studies using objective sleep measures are needed to confirm these associations and clarify underlying mechanisms.

The online version contains supplementary material available at 10.1007/s44470-025-00023-1.