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Sleep-disordered breathing and mortality: A prospective cohort study
PLoS Medicine, 08/21/09

Punjabi NM et al. – Sleep-disordered breathing is associated with all-cause mortality and specifically mortality due to coronary artery disease, particularly in men age 40–70 yrs with severe sleep-disordered breathing.

Methods

Study of whether sleep-disordered breathing and its sequelae of intermittent hypoxemia and recurrent arousals are associated with mortality in a community sample of adults age ≥40 yrs
Prospective evaluation of whether sleep-disordered breathing is associated with increased risk of death from any cause in 6,441 men and women participating in Sleep Heart Health Study
Sleep-disordered breathing assessed with apnea–hypopnea index (AHI) based on in-home polysomnogram
Survival analysis and proportional hazards regression models to calculate hazard ratios for mortality after adjusting for age, sex, race, smoking status, body mass index, and prevalent medical conditions
No sleep-disordered breathing: AHI <5 events/hr
Mild sleep-disordered breathing: AHI 5.0–14.9 events/hr
Moderate sleep-disordered breathing: AHI 15.0–29.9 events/hr
Severe sleep-disordered breathing: AHI ≥30.0 events/hr

Results

Average follow-up: 8.2 yrs, with mortality for 1,047 pts (587 men; 460 women) /
Fully adjusted hazard ratios for all-cause mortality in mild, moderate, and severe sleep-disordered breathing: 0.93, 1.17, and 1.46, respectively vs pts without sleep-disordered breathing
Sex- and age-stratified analyses: statistically significant increased risk of death associated with severe sleep-disordered breathing in men age 40–70 yrs
Measures of sleep-related intermittent hypoxemia, but not sleep fragmentation, 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

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