Obstructive Sleep Apnea and the Risk of Sudden Cardiac Death
Open accessAbstract
Objectives This study sought to identify the risk of sudden cardiac death (SCD) associated with obstructive sleep apnea (OSA).Background Risk stratification for SCD, a major cause of mortality, is difficult. OSA is linked to cardiovascular disease and arrhythmias and has been shown to increase the risk of nocturnal SCD. It is unknown if OSA independently increases the risk of SCD.Methods We included 10,701 consecutive adults undergoing their first diagnostic polysomnogram between July 1987 and July 2003. During follow-up up to 15 years, we assessed incident resuscitated or fatal SCD in relation to the presence of OSA, physiological data including the apnea-hypopnea index (AHI), and nocturnal oxygen saturation (O2sat) parameters, and relevant comorbidities.Results During an average follow-up of 5.3 years, 142 patients had resuscitated or fatal SCD (annual rate 0.27%). In multivariate analysis, independent risk factors for SCD were age, hypertension, coronary artery disease, cardiomyopathy or heart failure, ventricular ectopy or nonsustained ventricular tachycardia, and lowest nocturnal O2sat (per 10% decrease, hazard ratio [HR]: 1.14; p = 0.029). SCD was best predicted by age >60 years (HR: 5.53), apnea-hypopnea index >20 (HR: 1.60), mean nocturnal O2sat <93% (HR: 2.93), and lowest nocturnal O2sat <78% (HR: 2.60; all p < 0.0001).Conclusions In a population of 10,701 adults referred for polysomnography, OSA predicted incident SCD, and the magnitude of risk was predicted by multiple parameters characterizing OSA severity. Nocturnal hypoxemia, an important pathophysiological feature of OSA, strongly predicted SCD independently of well-established risk factors. These findings implicate OSA, a prevalent condition, as a novel risk factor for SCD.
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In a 15-year longitudinal follow-up of 10,071 adults, obstructive sleep apnea predicted incident sudden cardiac death, with the best predictors being age over 60 years, mean nocturnal oxygen saturation below 78%, and an apnea-hypopnea index above 20.
“In a 15-year longitudinal follow-up study of 10 071 adults, OSA predicted incident sudden cardiac death, with the best predictors being age >60 years, mean nocturnal oxygen saturation <78%, and AHI >20.27”
From Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2021) · cites this paper as [27]
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- Authors
- Gami, A. S., Olson, E. J., Shen, W. K., Wright, R. S., Ballman, K. V., Hodge, D. O., Herges, R. M., Howard, D. E., & Somers, V. K.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Somers, Virend K.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-08
- Volume
- 62
- Issue
- 7
- Pages
- 610-616
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC3851022
- OpenAlex
- W118661420
- Cited by
- 620
- References
- 30
- Citations by year
- 2026: 26 · 2025: 42 · 2024: 54 · 2023: 40 · 2022: 51 · 2021: 54 · 2020: 51 · 2019: 40 · 2018: 48 · 2017: 45 · 2016: 53 · 2015: 61 · 2014: 41 · 2013: 7
- FWCI
- 37.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (#HL65176, #NIH 1 UL1 RR024150)
- Phillips-Respironics Foundation to the Mayo Foundation
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Keywords
- obstructive sleep apnea, sudden cardiac death, nocturnal hypoxemia, apnea-hypopnea index, nocturnal oxygen saturation, risk factors, polysomnography, cardiovascular risk stratification, cardiac arrhythmias
- MeSH terms
- Adult, Aged, Cause of Death, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Retrospective Studies, Severity of Illness Index, Incidence, Multivariate Analysis, Death, Sudden, Cardiac, Polysomnography, Age Distribution, Sex Distribution, Risk Assessment, Sleep Apnea, Obstructive, Kaplan-Meier Estimate
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