03483nas a2200457 4500008004100000022001400041245007400055210006900129260001300198300001300211490000600224520223200230653000902462653002802471653001102499653001102510653001202521653000902533653001602542653001502558653003202573653002402605653001702629653001602646653002602662653002202688100002302710700002002733700002202753700002402775700002002799700002402819700002302843700001902866700002402885700002102909700001702930700001902947700002302966856003602989 2009 eng d a1549-167600aSleep-disordered breathing and mortality: a prospective cohort study.0 aSleepdisordered breathing and mortality a prospective cohort stu c2009 Aug ae10001320 v63 a
BACKGROUND: Sleep-disordered breathing is a common condition associated with adverse health outcomes including hypertension and cardiovascular disease. The overall objective of this study was to determine whether sleep-disordered breathing and its sequelae of intermittent hypoxemia and recurrent arousals are associated with mortality in a community sample of adults aged 40 years or older.
METHODS AND FINDINGS: We prospectively examined whether sleep-disordered breathing was associated with an increased risk of death from any cause in 6,441 men and women participating in the Sleep Heart Health Study. Sleep-disordered breathing was assessed with the apnea-hypopnea index (AHI) based on an in-home polysomnogram. Survival analysis and proportional hazards regression models were used to calculate hazard ratios for mortality after adjusting for age, sex, race, smoking status, body mass index, and prevalent medical conditions. The average follow-up period for the cohort was 8.2 y during which 1,047 participants (587 men and 460 women) died. Compared to those without sleep-disordered breathing (AHI: <5 events/h), the fully adjusted hazard ratios for all-cause mortality in those with mild (AHI: 5.0-14.9 events/h), moderate (AHI: 15.0-29.9 events/h), and severe (AHI: >or=30.0 events/h) sleep-disordered breathing were 0.93 (95% CI: 0.80-1.08), 1.17 (95% CI: 0.97-1.42), and 1.46 (95% CI: 1.14-1.86), respectively. Stratified analyses by sex and age showed that the increased risk of death associated with severe sleep-disordered breathing was statistically significant in men aged 40-70 y (hazard ratio: 2.09; 95% CI: 1.31-3.33). Measures of sleep-related intermittent hypoxemia, but not sleep fragmentation, were independently associated with all-cause mortality. Coronary artery disease-related mortality associated with sleep-disordered breathing showed a pattern of association similar to all-cause mortality.
CONCLUSIONS: Sleep-disordered breathing is associated with all-cause mortality and specifically that due to coronary artery disease, particularly in men aged 40-70 y with severe sleep-disordered breathing. Please see later in the article for the Editors' Summary.
10aAged10aCoronary Artery Disease10aFemale10aHumans10aHypoxia10aMale10aMiddle Aged10aOdds Ratio10aProportional Hazards Models10aProspective Studies10aRisk Factors10aSex Factors10aSleep Apnea Syndromes10aSurvival Analysis1 aPunjabi, Naresh, M1 aCaffo, Brian, S1 aGoodwin, James, L1 aGottlieb, Daniel, J1 aNewman, Anne, B1 aO'Connor, George, T1 aRapoport, David, M1 aRedline, Susan1 aResnick, Helaine, E1 aRobbins, John, A1 aShahar, Eyal1 aUnruh, Mark, L1 aSamet, Jonathan, M uhttps://chs-nhlbi.org/node/1122