Day–Night Pattern of Sudden Death in Obstructive Sleep Apnea
Open accessAbstract
BACKGROUND: The risk of sudden death from cardiac causes in the general population peaks from 6 a.m. to noon and has a nadir from midnight to 6 a.m. Obstructive sleep apnea is highly prevalent and associated with neurohormonal and electrophysiological abnormalities that may increase the risk of sudden death from cardiac causes, especially during sleep. METHODS: We reviewed polysomnograms and the death certificates of 112 Minnesota residents who had undergone polysomnography and had died suddenly from cardiac causes between July 1987 and July 2003. For four intervals of the day, we compared the rates of sudden death from cardiac causes among people with obstructive sleep apnea and the following: the rates among people without obstructive sleep apnea, the rates in the general population, and the expectations according to chance. For each interval, we assessed the median apnea-hypopnea index and the relative risk of sudden death from cardiac causes. We similarly analyzed sudden death from cardiac causes during three time intervals that correlate with usual sleep-wake cycles. RESULTS: From midnight to 6 a.m., sudden death from cardiac causes occurred in 46 percent of people with obstructive sleep apnea, as compared with 21 percent of people without obstructive sleep apnea (P=0.01), 16 percent of the general population (P<0.001), and the 25 percent expected by chance (P<0.001). People with sudden death from cardiac causes from midnight to 6 a.m. had a significantly higher apnea-hypopnea index than those with sudden death from cardiac causes during other intervals, and the apnea-hypopnea index correlated directly with the relative risk of sudden death from cardiac causes from midnight to 6 a.m. For people with obstructive sleep apnea, the relative risk of sudden death from cardiac causes from midnight to 6 a.m. was 2.57 (95 percent confidence interval, 1.87 to 3.52). The analysis of usual sleep-wake cycles showed similar results. CONCLUSIONS: People with obstructive sleep apnea have a peak in sudden death from cardiac causes during the sleeping hours, which contrasts strikingly with the nadir of sudden death from cardiac causes during this period in people without obstructive sleep apnea and in the general population.
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Obstructive sleep apnea is a highly prevalent syndrome associated with substantial morbidity and increased mortality.
“OBSTRUCTIVE SLEEP APNEA (OSA) IS A HIGHLY PREV-ALENT SYNDROME THAT IS ASSOCIATED WITH SUB-STANTIAL MORBIDITY AND INCREASED MORTALITY. 1-10”
In people with obstructive sleep apnea, the vulnerable period for sudden cardiac death is relatively advanced to the middle of the night rather than the morning.
“the vulnerable period for sudden cardiac death is relatively advanced to the middle of the night rather than the morning in people with obstructive sleep apnea (185).”
From Role of the circadian system in cardiovascular disease (2018) · cites this paper as [185]
In patients with sleep apnea, the peak in adverse cardiovascular events occurs at night.
“In patients with sleep apnea, however, the peak in adverse cardiovascular events occurs at night”
From The impact of the circadian timing system on cardiovascular and metabolic function (2012) · cites this paper as Gami et al., 2005
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Suen, C., Wong, J., Ryan, C. M., Goh, S., Got, T., Chaudhry, R., Lee, D. S., & Chung, F. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9040989 · Cited by 37 · see citing works
Impact of Obstructive Sleep Apnoea on Heart Failure with Preserved Ejection Fraction
Arikawa, T., Toyoda, S., Haruyama, A., Amano, H., Inami, S., Otani, N., Sakuma, M., Taguchi, I., Abe, S., Node, K., et al. (2016) · Heart, Lung and Circulation · doi:10.1016/j.hlc.2015.09.011 · Cited by 27 · see citing works
Peri-operative treatment of sleep-disordered breathing and outcomes in bariatric patients
Meurgey, J.-H., Brown, R., Woroszyl-Chrusciel, A., & Steier, J. (2018) · Journal of Thoracic Disease · doi:10.21037/jtd.2017.10.11 · Cited by 19 · see citing works
- Authors
- Gami, A. S., Howard, D. E., Olson, E. J., & Somers, V. K.
- Affiliations
- Mayo Clinic (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2005-03-24
- Volume
- 352
- Issue
- 12
- Pages
- 1206-1214
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2093457132
- Cited by
- 1,032
- References
- 41
- Citations by year
- 2026: 16 · 2025: 23 · 2024: 32 · 2023: 24 · 2022: 40 · 2021: 38 · 2020: 38 · 2019: 30 · 2018: 54 · 2017: 46 · 2016: 59 · 2015: 61 · 2014: 58 · 2013: 62 · 2012: 75
- FWCI
- 40.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (M01 R-00585)
- National Heart, Lung, and Blood Institute (HL65176, R01HL073211, R01HL065176, HL61560, HL73211, R01HL061560)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- obstructive sleep apnea, sudden cardiac death, apnea-hypopnea index, sleep-wake cycle, nocturnal apnea, relative risk, polysomnography, death certificates
- MeSH terms
- Aged, Circadian Rhythm, Female, Humans, Male, Middle Aged, Risk, Sleep, Death, Sudden, Cardiac, Polysomnography, Sleep Apnea, Obstructive
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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