Mild‐to‐moderate obstructive sleep apnea and mortality risk in a general population sample: The modifying effect of age and cardiovascular/cerebrovascular comorbidity

Abstract

SummaryAbout 5.4%–45.7% of the general population has mild‐to‐moderate obstructive sleep apnea (mmOSA), which is highly comorbid with cardiovascular and/or cerebrovascular diseases (CBVD). We examined the association between mmOSA and all‐cause mortality and the modifying effect of age and CBVD. A total of 1681 adults 20–88 years old from the Penn State Adult Cohort (PSAC) (41.9% male) were followed up for 20.1 ± 6.2 years for all‐cause mortality. Mild and moderate OSA were defined as an apnea/hypopnea index (AHI) 5–14.9 and 15–29.9 events/hour, respectively. CBVD was defined as a report of a physician diagnosis or treatment for heart disease and/or stroke. Cox proportional hazards regression models were used to estimate all‐cause mortality adjusted for confounders. All‐cause mortality risk was significantly increased in the mmOSA group in young and middle‐aged adults (<60 years) (HR = 1.59, 95%CI 1.08–2.04) but not in older adults (≥60 years) (HR = 1.05, 95%CI 0.80–1.39). A synergistic effect between mmOSA and CBVD was stronger in those <60 years (HR = 3.82, 95%CI 2.25–6.48 in <60 years vs 1.86 95%CI 1.14–3.04 in ≥60 years). There was an additive effect between moderate OSA and hypertension in <60 but not in those ≥60 years. Mild OSA was associated with all‐cause mortality only in the presence of CBVD. Mortality risk is increased in young and middle‐aged adults with moderate OSA, whereas the mortality risk associated with mild OSA is elevated only, regardless of age, in the presence of comorbid CBVD. AHI cut‐offs warranting treatment of mmOSA may need to be adjusted based on age and comorbidities.

Correlation between obstructive sleep apnea and hypoperfusion in patients with acute cerebral infarction

“…The relationship between OSA and cerebral infarction remains controversial. Studies have suggested that OSA can lead to an adverse prognosis in cerebral infarction, impair brain function, exacerbate cognitive dysfunction, and increase mortality risk (30)(31)(32)(33). The main mechanisms underlying these adverse outcomes include chronic intermittent hypoxia, sympathetic activation, changes in cerebral blood flow, oxidative stress, systemic inflammation, hypercoagulability, and endothelial dysfunction (34,35).…”

Chronic intermittent hypoxia reveals role of the Postinspiratory Complex in the mediation of normal swallow production

“…CIH increases the gain of the carotid body response to hypoxia, which seems to be a major cause for the multiple comorbidities of OSA ( Iturriaga, 2023 ; Prabhakar et al, 2023 ). These OSA-related comorbidities ( Pack, 2023 ) include an increase in mortality ( Vgontzas et al, 2023 ) and cancer risk ( Sánchez-de-la-Torre et al, 2023 ), increased arousal and sleep fragmentation ( Horner, 2023 ), increased sympathetic drive leading to cardiovascular disease, metabolic syndromes such as obesity and diabetes ( Kurnool et al, 2023 ), renal disease, asthma ( Bonsignore et al, 2019 ), and decreased cognition ( Brockmann and Gozal, 2022 ). OSA is also commonly associated with altered and disordered swallow function, clinically known as dysphagia ( Pizzorni et al, 2021 ; Schindler et al, 2014 ).…”

Chronic Intermittent Hypoxia reveals role of the Postinspiratory Complex in the mediation of normal swallow production

“…CIH increases the gain of the carotid body (CB) response to hypoxia which seems to be a major cause for the multiple comorbidities of OSA (Iturriaga, 2023;Prabhakar et al, 2023). These OSA-related comorbidities (Pack, 2023) include an increase in mortality (Vgontzas et al, 2023) and cancer risk (Sánchez-de-la-Torre et al, 2023), increased arousal and sleep fragmentation (Horner, 2023), increased sympathetic drive leading to cardiovascular disease; metabolic syndromes such as obesity and diabetes (Kurnool et al, 2023), renal disease, asthma, (Bonsignore et al, 2019), and decreased cognition (Brockmann & Gozal, 2022). OSA is also commonly associated with dysphagia, disordered swallow function (Pizzorni et al, 2021;Schindler et al, 2014).…”