Abstract
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.
Data availability
The dataset associated with this study is stored in a proprietary repository (Withings) and cannot be shared publicly due to concern for privacy, ethical, and legal reasons. The investigator team accessed the data through an application process to Withings, and a formal data sharing agreement designed to safeguard user confidentiality, as outlined in the terms and conditions and privacy policy documentation. Queries for data access can be directed to Withings (data_compliance@withings.com) with a timeframe for response of four weeks. Specific de-identified raw data that support the findings of this study, including individual data, are available from the corresponding author (lucia.pinilla@flinders.edu.au) upon request subject to ethical and data custodian (Withings) approval described above. The timeframe for response to requests will be up to four weeks.
Code availability
The underlying code for this study is not publicly available but may be made available to qualified researchers on reasonable request from the corresponding author (lucia.pinilla@flinders.edu.au).
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Acknowledgements
This was an investigator-initiated study led by the Adelaide Institute for Sleep Health sleep research team, therefore, there is no specific grant number. J.L.P. is supported by the French National Research Agency (ANR) in the framework of the "FRANCE 2030” program, the “e-health and integrated care” chair of Grenoble Alpes University Foundation and “Sleep Health-AI chair” in “MIAI Cluster” of artificial intelligence (ANR-23-IACL-0006). B.L. and D.J.E. are supported by National Health and Medical Research Council of Australia Fellowships.
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L.P., B.L., and D.J.E. conceived and designed the study. B.L. performed data extraction. B.L., L.P., K.S., and D.J.E. conducted the data analysis and interpretation. LP drafted the manuscript. B.L., K.S., P.L., A.V., A.M., A.H., P.E., J.L.P., R.A., P.C., and D.J.E. provided critical input on data interpretation and contributed to revision of the manuscript. All authors had full access to the data, reviewed and approved the final manuscript, and accept responsibility for its submission for publication.
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P.L. receives partial PhD funding from Withings. P.E. is consultant for Withings. J.L.P. reports income related to medical education from RESMED, SEFAM, Philips, Zoll-Respicardia, Eli Lilly, Idorsia, Pharmanovia, Biosency and Bioprojet. Outside the submitted work, D.J.E. has had research grants from Bayer, Apnimed, Takeda, Invicta Medical (now Restera), and Eli Lilly. D.J.E. currently serves as a scientific advisor/consultant for Apnimed, Invicta Medical (now Restera), Restora, Takeda, SleepRes, Mosanna and humanity Medtech. L.P., K.S., A.V., A.M., A.H., R.A., P.C., and B.L. declare no financial or non-financial competing interests.
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Pinilla, L., Sansom, K., Letzelter, P. et al. Multi night digital assessment of sleep disordered breathing is associated with accelerated vascular aging. npj Digit. Med. (2026). https://doi.org/10.1038/s41746-026-02469-w
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DOI: https://doi.org/10.1038/s41746-026-02469-w
