The performance of electrocardiographic (ECG) voltage criteria to identify left and right ventricular hypertrophy (LVH and RVH) in young Asian female adults have not been clarified so far. In a sample of 255 military young female adults, aged 25.2 years on average, echocardiographic LVH was respectively defined as the left ventricular mass (LVM) indexed by body surface area (BSA) (≥88 g/m 2 ) and by height 2.7 (≥41 g/m 2.7 ), and RVH was defined as anterior right ventricular wall thickness >5.2 mm. The performance of ECG voltage criteria for the echocardiographic LVH and RVH were assessed by area under curve (AUC) of receiver operating characteristic (ROC) curve to estimate sensitivity and specificity. For the Sokolow-Lyon (the maximum of SV 1 or SV 2 + RV 5 or RV 6 ) and Cornell (RaVL + SV 3 ) voltage criteria with the LVM/BSA ≥88 g/m 2 , the AUC of ROC curves were 0.66 (95% confidence intervals [CI]: 0.52–0.81, P = .039) and 0.61 (95% CI: 0.44–0.77, P = .18), respectively. For these 2 ECG voltage criteria with the LVM/height 2.7 ≥41 g/m 2.7 , the AUC of ROC curves were 0.64 (95% CI: 0.52–0.75, P = 0.11) and 0.73 (95% CI: 0.61–0.85, P = 0.0074), respectively. The best cut-off points selected for the Sokolow-Lyon and Cornell voltage criteria with echocardiographic LVH in young Asian females were 26 mm and 6 mm, respectively. In contrast, all the AUC of ROC curves were less than 0.60 and not significant according to the Sokolow-Lyon (the maximum of RV1 + SV5 or V6) and Myers’ voltage criteria (eg, the voltage of R wave in V1 and the ratios of R/S in V1, V5 and V6) with echocardiographic RVH. There was a suggestion that the ECG voltage criteria to screen the presence of LVH should be adjusted for the young Asian female adults, and with regard to RVH, the ECG voltage criteria were found ineffective.

Obstructive sleep apnea (OSA) causes intermittent nocturnal hypoxemia and is associated with obesity, diabetes, inflammation, endothelial dysfunction, and hypertension, possibly leading to micro-and macro-vascular disease. OSA has been associated with higher risk of clinical cardiovascular disease (CVD) independent of traditional risk factors and severity of atherosclerosis. Microvascular disease may be a potential mediator for the association of OSA with clinical CVD. However, evidence for the association between OSA and microvascular dysfunction is conflicting. Since the retinal microvasculature is structurally and functionally similar to microvasculature elsewhere in the body and can be directly visualized via ophthalmoscopy, several studies have assessed the relationship of OSA with retinal microvascular characteristics but shown inconsistent results. Notably, the multi-ethnic study of atherosclerosis (MESA) recently revealed that the associations of OSA severity with retinal microvascular signs may differ by sex. Moderate/severe OSA was associated with retinal vascular calibers in men, but not women. In contrast, severe OSA was associated with retinal microaneurysms in women but not men. To our knowledge, the clinical course of OSA differs by sex with women on average having less severe sleep apnea than men at younger ages, with differences narrowing after menopause. Whether these findings in MESA were related to sex differences in OSA exposure needs further study. Moreover, whether sex-specific effects of OSA manifest on the microvascularature in other sites, including arterioles, venules, and vasa vasorum, also deserves investigation.