Multi night digital assessment of sleep disordered breathing is associated with accelerated vascular aging

Pulse wave velocity (PWV) is a marker of vascular aging and cardiovascular risk. Obstructive sleep apnea (OSA) may accelerate vascular decline, but evidence from single-night assessments is inconsistent. We examined associations of multi-night OSA severity, night-to-night variability, and snoring with arterial stiffness in a real-world setting. Adults used two in-home digital devices over a ~ 4 y period: an under-mattress sleep sensor to quantify nightly OSA severity and snoring, and a smart scale to measure aortic-leg PWV. Among 29,653 participants from 20 countries (52 ± 12 years; 84% male; BMI 27.3 ± 4.9 kg/m²), increasing OSA severity was associated with higher PWV in a dose-response manner, independent of age, sex, and BMI. Participants with mild OSA but high variability had PWV levels comparable to severe OSA. Higher snoring burden independently predicted higher PWV across OSA severity categories. Multi-night in-home assessments of OSA and snoring may better reflect cardiovascular risk with potential to inform personalized management.