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Sleep-disordered breathing and mortality: A prospective cohort study

Punjabi, NM and Caffo, BS and Goodwin, JL and Gottlieb, DJ and Newman, AB and O'Connor, GT and Rapoport, DM and Redline, S and Resnick, HE and Robbins, JA and Shahar, E and Unruh, ML and Samet, JM (2009) Sleep-disordered breathing and mortality: A prospective cohort study. PLoS Medicine, 6 (8). ISSN 1549-1277

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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: ≥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. © 2009 Punjabi et al.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Punjabi, NM
Caffo, BS
Goodwin, JL
Gottlieb, DJ
O'Connor, GT
Rapoport, DM
Redline, S
Resnick, HE
Robbins, JA
Shahar, E
Unruh, ML
Samet, JM
ContributionContributors NameEmailPitt UsernameORCID
Date: 1 August 2009
Date Type: Publication
Journal or Publication Title: PLoS Medicine
Volume: 6
Number: 8
DOI or Unique Handle: 10.1371/journal.pmed.1000132
Refereed: Yes
ISSN: 1549-1277
MeSH Headings: Aged; Anoxia--complications; Anoxia--mortality; Coronary Artery Disease--complications; Coronary Artery Disease--mortality; Female; Humans; Male; Middle Aged; Odds Ratio; Proportional Hazards Models; Prospective Studies; Risk Factors; Sex Factors; Sleep Apnea Syndromes--complications; Sleep Apnea Syndromes--mortality; Survival Analysis
Other ID: NLM PMC2722083
PubMed Central ID: PMC2722083
PubMed ID: 19688045
Date Deposited: 03 Aug 2012 16:09
Last Modified: 22 May 2019 12:55


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