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Cited by 1,853Obstructive Sleep Apnea ResearchSleep and related disordersNeuroscience of respiration and sleep

Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up of the Wisconsin Sleep Cohort

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Terry B Young, Laurel Ann Finn, Paul E. Peppard, Mariana Szklo‐Coxe, Diane Austin, MS, F. Javier Nieto, Robin Stubbs, Khin Mae Hla·2008·Sleep
DOI 10.5665/sleep/31.8.1071PMC PMC2542952
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Abstract

BACKGROUND: Sleep-disordered breathing (SDB) is a treatable but markedly under-diagnosed condition of frequent breathing pauses during sleep. SDB is linked to incident cardiovascular disease, stroke, and other morbidity. However, the risk of mortality with untreated SDB, determined by polysomnography screening, in the general population has not been established. METHODS: An 18-year mortality follow-up was conducted on the population-based Wisconsin Sleep Cohort sample (n = 1522), assessed at baseline for SDB with polysomnography, the clinical diagnostic standard. SDB was described by the number of apnea and hypopnea episodes/hour of sleep; cutpoints at 5, 15 and 30 identified mild, moderate, and severe SDB, respectively. Cox proportional hazards regression was used to estimate all-cause and cardiovascular mortality risks, adjusted for potential confounding factors, associated with SDB severity levels. RESULTS: All-cause mortality risk, adjusted for age, sex, BMI, and other factors was significantly increased with SDB severity. The adjusted hazard ratio (HR, 95% CI) for all-cause mortality with severe versus no SDB was 3.0 (1.4,6.3). After excluding persons who had used CPAP treatment (n = 126), the adjusted HR (95% CI) for all-cause mortality with severe versus no SDB was 3.8 (1.6,9.0); the adjusted HR (95% CI) for cardiovascular mortality was 5.2 (1.4,19.2). Results were unchanged after accounting for daytime sleepiness. CONCLUSIONS: Our findings of a significant, high mortality risk with untreated SDB, independent of age, sex, and BMI underscore the need for heightened clinical recognition and treatment of SDB, indicated by frequent episodes of apnea and hypopnea, irrespective of symptoms of sleepiness.

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  • An increased risk of cardiopulmonary disease and mortality has been established for clinically relevant OSA (AHI ≥ 15).

    “where an increased risk of cardiopulmonary disease and mortality has been established (true positive)432–434”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [434]

    The Discussion and Table 6 report significantly increased all-cause and cardiovascular mortality for severe sleep-disordered breathing (AHI ≥30), but not for moderate disease (AHI 15–<30). The Abstract says sleep-disordered breathing is linked to incident cardiovascular disease; this study does not establish increased cardiopulmonary disease risk across the claimed AHI ≥15 group. Page numbers were not supplied in our copy. (LLM, conf=0.88)

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Cites

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Cited by

Sorted by citations

Authors
Young, T. B., Finn, L. A., Peppard, P. E., Szklo‐Coxe, M., Diane Austin, M., Nieto, F. J., Stubbs, R., & Hla, K. M.
Affiliations
University of Wisconsin–Madison (US)
Corresponding author
Terry B Young
ORCID
Venue
Sleep
Publisher
Oxford University Press (OUP)
Published
2008-08-01
Volume
31
Issue
8
Pages
1071-8
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.5665/sleep/31.8.1071
PMC
PMC2542952
OpenAlex
W4320300889
Cited by
1,853
References
4
Citations by year
2026: 12 · 2025: 44 · 2024: 72 · 2023: 72 · 2022: 75 · 2021: 105 · 2020: 120 · 2019: 124 · 2018: 116 · 2017: 113 · 2016: 132 · 2015: 155 · 2014: 147 · 2013: 150 · 2012: 118
FWCI
64.96
Type
journal article
Language
en
Open access
Locations
  • SLEEP (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed
Funders
  • University of Wisconsin-Madison
  • National Institutes of Health
  • National Institute on Aging (R01AG014124)
  • National Heart, Lung, and Blood Institute (R01HL062252)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
Keywords
sleep-disordered breathing, mortality, cardiovascular mortality, all-cause mortality, apnea-hypopnea index, untreated sleep apnea, continuous positive airway pressure, daytime sleepiness, polysomnography screening
MeSH terms
Adult, Aged, Cardiovascular Diseases, Cause of Death, Female, Follow-Up Studies, Humans, Male, Middle Aged, Risk, Wisconsin, Cohort Studies, Proportional Hazards Models, Survival Analysis, Polysomnography, Sleep Apnea, Obstructive, Stroke

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