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J Clin Sleep Med. 2014 Apr 15;10(4):355-62. doi: 10.5664/jcsm.3600.

Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort.

Author information

1
NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia ; Sydney Nursing School, University of Sydney, Sydney, Australia.
2
NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia ; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.
3
Western Australian Sleep Disorders Research Institute, Perth, Australia.
4
School of Population Health, University of Western Australia, Perth, Australia.

Abstract

OBJECTIVE:

To ascertain whether objectively measured obstructive sleep apnea (OSA) independently increases the risk of all cause death, cardiovascular disease (CVD), coronary heart disease (CHD), stroke or cancer.

DESIGN:

Community-based cohort.

SETTING AND PARTICIPANTS:

400 residents of the Western Australian town of Busselton.

MEASURES:

OSA severity was quantified via the respiratory disturbance index (RDI) as measured by a single night recording in November-December 1990 using the MESAM IV device, along with a range of other risk factors. Follow-up for deaths and hospitalizations was ascertained via record linkage to the end of 2010.

RESULTS:

We had follow-up data in 397 people and then removed those with a previous stroke (n = 4) from the mortality/ CVD/CHD/stroke analyses and those with cancer history from the cancer analyses (n = 7). There were 77 deaths, 103 cardiovascular events (31 strokes, 59 CHD) and 125 incident cases of cancer (39 cancer fatalities) during 20 years follow-up. In fully adjusted models, moderate-severe OSA was significantly associated with all-cause mortality (HR = 4.2; 95% CI 1.9, 9.2), cancer mortality (3.4; 1.1, 10.2), incident cancer (2.5; 1.2, 5.0), and stroke (3.7; 1.2, 11.8), but not significantly with CVD (1.9; 0.75, 4.6) or CHD incidence (1.1; 0.24, 4.6). Mild sleep apnea was associated with a halving in mortality (0.5; 0.27, 0.99), but no other outcome, after control for leading risk factors.

CONCLUSIONS:

Moderate-to-severe sleep apnea is independently associated with a large increased risk of all-cause mortality, incident stroke, and cancer incidence and mortality in this community-based sample.

KEYWORDS:

Sleep disordered breathing; coronary artery disease; melanoma

PMID:
24733978
PMCID:
PMC3960375
DOI:
10.5664/jcsm.3600
[Indexed for MEDLINE]
Free PMC Article

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