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Cited by 889Obstructive Sleep Apnea ResearchSleep and related disordersNeuroscience of respiration and sleep

Sleep Apnea as an Independent Risk Factor for All-Cause Mortality: The Busselton Health Study

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Nathaniel S. Marshall, KEITH K. H. WONG, Peter Y. Liu, Stewart R.J. Cullen, Matthew William Knuiman, Ronald R. Grunstein·2008·Sleep
DOI 10.5665/sleep/31.8.1079PMC PMC2542953
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Abstract

BACKGROUND: Previously published cohort studies in clinical populations have suggested that obstructive sleep apnea (OSA) is a risk factor for mortality associated with cardiovascular disease. However, it is unknown whether sleep apnea is an independent risk factor for all-cause mortality in a community-based sample free from clinical referral bias. METHODS: Residents of the Western Australian town of Busselton underwent investigation with a home sleep apnea monitoring device (MESAM IV). OSA was quantified via the respiratory disturbance index (RDI). Mortality status was determined in 397/400 participants (99.3%) after up to 14 years (mean follow-up 13.4 years) by data matching with the Australian National Death Index and the Western Australian Death Register. Univariate analyses and multivariate Cox proportional hazards modelling were used to ascertain the association between sleep apnea and mortality after adjustment for age, gender, body mass index, mean arterial pressure, total cholesterol, high-density lipoprotein cholesterol, diabetes, and medically diagnosed angina in those free from heart attack or stroke at baseline (n = 380). RESULTS: Among the 380 participants, 18 had moderate-severe OSA (RDI > or = 15/hr, 6 deaths) and 77 had mild OSA(RDI 5 to < 15/hr, 5 deaths). Moderate-to-severe OSA was independently associated with greater risk of all-cause mortality (fully adjusted hazard ratio [HR] = 6.24, 95% CL 2.01, 19.39) than non-OSA (n = 285, 22 deaths). Mild OSA (RDI 5 to < 15/hr) was not an independent risk factor for higher mortality (HR = 0.47, 95% CL 0.17, 1.29). CONCLUSIONS: Moderate-to-severe sleep apnea is independently associated with a large increased risk of all-cause mortality in this community-based sample.

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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 [433]

    The Abstract (page not provided) reports that moderate-to-severe OSA, defined by RDI ≥15/hr, was independently associated with increased all-cause mortality. The Introduction (page not provided) describes evidence linking OSA to cardiovascular conditions, but this study did not establish an increased risk of cardiopulmonary disease; it also cautions that causation is difficult to establish. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • There is a movement toward using more objective outcomes such as ODI and/or a 50% AHI decrease to under 15 events/h, which correlates with long-term health risk and mortality.

    “However, there is a movement toward using more objective outcomes (e.g., ODI) and/or a 50% AHI decrease to under 15 events/h into the mild OSA range, which correlates with long-term health risk and mortality.114,118,433,434,638,642,660,683”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [433]

    The Results (page unavailable) associate higher baseline RDI with long-term all-cause mortality, and the paper classifies RDI below 15 events/hour as mild OSA. It does not assess ODI or a 50% reduction in AHI as outcomes, or report a movement toward using those measures. An association between baseline severity and mortality does not establish that achieving the proposed reduction changes long-term risk. (LLM, conf=0.88)

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Authors
Marshall, N. S., WONG, K. K. H., Liu, P. Y., Cullen, S. R. J., Knuiman, M. W., & Grunstein, R. R.
Affiliations
  • The University of Sydney (AU)
  • West Australian Sleep Disorders Research Institute (AU)
  • The University of Western Australia (AU)
Corresponding author
Nathaniel S. Marshall
ORCID
Venue
Sleep
Publisher
Oxford University Press (OUP)
Published
2008-08-01
Volume
31
Issue
8
Pages
1079-85
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.5665/sleep/31.8.1079
PMC
PMC2542953
OpenAlex
W2098983190
Cited by
889
References
3
Citations by year
2026: 3 · 2025: 15 · 2024: 34 · 2023: 29 · 2022: 39 · 2021: 41 · 2020: 51 · 2019: 49 · 2018: 60 · 2017: 46 · 2016: 58 · 2015: 48 · 2014: 84 · 2013: 88 · 2012: 74
FWCI
38.02
Type
journal article
Language
en
Open access
Locations
  • SLEEP (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UWA Profiles and Research Repository (UWA) (submittedVersion)
Funders
National Health and Medical Research Council
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
obstructive sleep apnea, all-cause mortality, respiratory disturbance index, community-based cohort, cardiovascular risk factors, mortality risk
MeSH terms
Adult, Aged, Cardiovascular Diseases, Cause of Death, Female, Follow-Up Studies, Humans, Male, Middle Aged, Risk, Sampling Studies, Western Australia, Proportional Hazards Models, Polysomnography, Monitoring, Ambulatory, Sleep Apnea, Obstructive

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