Long-term All-Cause Mortality Risk in Obstructive Sleep Apnea Using Hypopneas Defined by a ≥3 Percent Oxygen Desaturation or Arousal

Abstract

Study Objectives: Some prior studies have demonstrated an increase in mortality associated with obstructive sleep apnea (OSA) utilizing a definition of OSA that requires a minimum 4% oxygen desaturation to identify a hypopnea. No large community-based studies have determined the risk of long-term mortality with OSA with hypopneas defined by a ≥3% O2 desaturation or arousal (AHI3%A). Methods: Data from 5591 Sleep Heart Health Study participants without prevalent cardiovascular disease at baseline who underwent polysomnography were analyzed regarding OSA diagnosed using the AHI3%A criteria and all-cause mortality over a mean follow up period of 10.9±3.2 years. Results: There were 1050 deaths in this group during the follow-up period. A Kaplan-Meir plot of survival revealed a reduction in survival with increasing AHI severity. Cox proportional hazards regression models revealed significantly increased all-cause mortality risk with increasing AHI, hazard ratio (HR, 95% CI) 1.13 (1.04-1.23), after adjusting for age, sex, race, BMI, cholesterol, HDL, self-reported hypertension and/or diabetes and smoking status. In categorical models, the mortality risk was significantly higher with severe OSA [adjusted HR 1.38 (1.09-1.76)]. When stratified by gender or age, severe OSA was associated with increased risk of death in men [adjusted HR 1.14 (1.01-1.28)] and in those <70 years of age [adjusted HR 1.51 (1.02-2.26)]. In contrast, AHI severity was not associated with increased mortality in women or those ≥70 years of age in fully adjusted models. Conclusion: Severe AHI3%A OSA is associated with significantly increased mortality risk, especially in men and those <70 years of age.

Validation of a Wearable Medical Device for Automatic Diagnosis of OSA against Standard PSG

“…Moreover, OSA has been linked to an increased risk of developing other health conditions, such as high blood pressure, ischemic heart disease, and dementia [4][5][6][7]. And untreated OSA is associated with an increased risk of all-cause and cardiovascular mortality [8]. Aside from the physical and emotional toll that obstructive sleep apnea takes on individuals, it also carries a significant financial burden; the costs, both direct and indirect, have been demonstrated to be huge [9].…”