Mild‐to‐moderate obstructive sleep apnea and mortality risk in a general population sample: The modifying effect of age and cardiovascular/cerebrovascular comorbidity

Abstract

SummaryAbout 5.4%–45.7% of the general population has mild‐to‐moderate obstructive sleep apnea (mmOSA), which is highly comorbid with cardiovascular and/or cerebrovascular diseases (CBVD). We examined the association between mmOSA and all‐cause mortality and the modifying effect of age and CBVD. A total of 1681 adults 20–88 years old from the Penn State Adult Cohort (PSAC) (41.9% male) were followed up for 20.1 ± 6.2 years for all‐cause mortality. Mild and moderate OSA were defined as an apnea/hypopnea index (AHI) 5–14.9 and 15–29.9 events/hour, respectively. CBVD was defined as a report of a physician diagnosis or treatment for heart disease and/or stroke. Cox proportional hazards regression models were used to estimate all‐cause mortality adjusted for confounders. All‐cause mortality risk was significantly increased in the mmOSA group in young and middle‐aged adults (<60 years) (HR = 1.59, 95%CI 1.08–2.04) but not in older adults (≥60 years) (HR = 1.05, 95%CI 0.80–1.39). A synergistic effect between mmOSA and CBVD was stronger in those <60 years (HR = 3.82, 95%CI 2.25–6.48 in <60 years vs 1.86 95%CI 1.14–3.04 in ≥60 years). There was an additive effect between moderate OSA and hypertension in <60 but not in those ≥60 years. Mild OSA was associated with all‐cause mortality only in the presence of CBVD. Mortality risk is increased in young and middle‐aged adults with moderate OSA, whereas the mortality risk associated with mild OSA is elevated only, regardless of age, in the presence of comorbid CBVD. AHI cut‐offs warranting treatment of mmOSA may need to be adjusted based on age and comorbidities.