Apnea-hypopnea event duration predicts mortality in men and women in the sleep heart health study

Matthew Butler, Jeffery T. Emch, Michael Rueschman, Scott A. Sands, Steven Shea, Andrew Wellman, Susan Redline

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Rationale: Obstructive sleep apnea is a risk factor formortality, but its diagnostic metric-the apnea-hypopnea index-is a poor risk predictor. The apnea-hypopnea index does not capture the range of physiological variability within and between patients, such as degree of hypoxemia and sleep fragmentation, that reflect differences in pathophysiological contributions of airway collapsibility, chemoreceptive negative feedback loop gain, and arousal threshold. Objectives: To test whether respiratory event duration, a heritable sleep apnea trait reflective of arousal threshold, predicts all-cause mortality. Methods: Mortality risk as a function of event duration was estimated by Cox proportional hazards in the Sleep Heart Health Study, a prospective community-based cohort. Gender-specific hazard ratios were also calculated. Measurements and Main Results: Among 5,712 participants, 1,290 deaths occurred over 11 years of follow-up. After adjusting for demographic factors (mean age, 63 yr; 52% female), apnea- hypopnea index (mean, 13.8; SD, 15.0), smoking, and prevalent cardiometabolic disease, individuals with the shortest-duration events had a significant hazard ratio for all-cause mortality of 1.31 (95% confidence interval, 1.11-1.54). This relationship was observed in both men and women and was strongest in those with moderate sleep apnea (hazard ratio, 1.59; 95% confidence interval, 1.11-2.28). Conclusions: Short respiratory event duration, a marker for low arousal threshold, predicts mortality in men and women. Individuals with shorter respiratory events may be predisposed to increased ventilatory instability and/or have augmented autonomic nervous system responses that increase the likelihood of adverse health outcomes, underscoring the importance of assessing physiological variation in obstructive sleep apnea.

Original languageEnglish (US)
Pages (from-to)903-912
Number of pages10
JournalAmerican journal of respiratory and critical care medicine
Volume199
Issue number7
DOIs
StatePublished - Apr 1 2019

Fingerprint

Apnea
Sleep
Arousal
Mortality
Sleep Apnea Syndromes
Health
Obstructive Sleep Apnea
Confidence Intervals
Sleep Deprivation
Autonomic Nervous System
Smoking
Demography
Prospective Studies

Keywords

  • Epidemiology
  • Mortality
  • Obstructive sleep apnea
  • Prospective
  • Sleep

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Apnea-hypopnea event duration predicts mortality in men and women in the sleep heart health study. / Butler, Matthew; Emch, Jeffery T.; Rueschman, Michael; Sands, Scott A.; Shea, Steven; Wellman, Andrew; Redline, Susan.

In: American journal of respiratory and critical care medicine, Vol. 199, No. 7, 01.04.2019, p. 903-912.

Research output: Contribution to journalArticle

Butler, Matthew ; Emch, Jeffery T. ; Rueschman, Michael ; Sands, Scott A. ; Shea, Steven ; Wellman, Andrew ; Redline, Susan. / Apnea-hypopnea event duration predicts mortality in men and women in the sleep heart health study. In: American journal of respiratory and critical care medicine. 2019 ; Vol. 199, No. 7. pp. 903-912.
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abstract = "Rationale: Obstructive sleep apnea is a risk factor formortality, but its diagnostic metric-the apnea-hypopnea index-is a poor risk predictor. The apnea-hypopnea index does not capture the range of physiological variability within and between patients, such as degree of hypoxemia and sleep fragmentation, that reflect differences in pathophysiological contributions of airway collapsibility, chemoreceptive negative feedback loop gain, and arousal threshold. Objectives: To test whether respiratory event duration, a heritable sleep apnea trait reflective of arousal threshold, predicts all-cause mortality. Methods: Mortality risk as a function of event duration was estimated by Cox proportional hazards in the Sleep Heart Health Study, a prospective community-based cohort. Gender-specific hazard ratios were also calculated. Measurements and Main Results: Among 5,712 participants, 1,290 deaths occurred over 11 years of follow-up. After adjusting for demographic factors (mean age, 63 yr; 52{\%} female), apnea- hypopnea index (mean, 13.8; SD, 15.0), smoking, and prevalent cardiometabolic disease, individuals with the shortest-duration events had a significant hazard ratio for all-cause mortality of 1.31 (95{\%} confidence interval, 1.11-1.54). This relationship was observed in both men and women and was strongest in those with moderate sleep apnea (hazard ratio, 1.59; 95{\%} confidence interval, 1.11-2.28). Conclusions: Short respiratory event duration, a marker for low arousal threshold, predicts mortality in men and women. Individuals with shorter respiratory events may be predisposed to increased ventilatory instability and/or have augmented autonomic nervous system responses that increase the likelihood of adverse health outcomes, underscoring the importance of assessing physiological variation in obstructive sleep apnea.",
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AB - Rationale: Obstructive sleep apnea is a risk factor formortality, but its diagnostic metric-the apnea-hypopnea index-is a poor risk predictor. The apnea-hypopnea index does not capture the range of physiological variability within and between patients, such as degree of hypoxemia and sleep fragmentation, that reflect differences in pathophysiological contributions of airway collapsibility, chemoreceptive negative feedback loop gain, and arousal threshold. Objectives: To test whether respiratory event duration, a heritable sleep apnea trait reflective of arousal threshold, predicts all-cause mortality. Methods: Mortality risk as a function of event duration was estimated by Cox proportional hazards in the Sleep Heart Health Study, a prospective community-based cohort. Gender-specific hazard ratios were also calculated. Measurements and Main Results: Among 5,712 participants, 1,290 deaths occurred over 11 years of follow-up. After adjusting for demographic factors (mean age, 63 yr; 52% female), apnea- hypopnea index (mean, 13.8; SD, 15.0), smoking, and prevalent cardiometabolic disease, individuals with the shortest-duration events had a significant hazard ratio for all-cause mortality of 1.31 (95% confidence interval, 1.11-1.54). This relationship was observed in both men and women and was strongest in those with moderate sleep apnea (hazard ratio, 1.59; 95% confidence interval, 1.11-2.28). Conclusions: Short respiratory event duration, a marker for low arousal threshold, predicts mortality in men and women. Individuals with shorter respiratory events may be predisposed to increased ventilatory instability and/or have augmented autonomic nervous system responses that increase the likelihood of adverse health outcomes, underscoring the importance of assessing physiological variation in obstructive sleep apnea.

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