Issue Navigator

Volume 10 No. 04
Earn CME
Accepted Papers
Classifieds







Scientific Investigations

Sleep Apnea and 20-Year Follow-Up for All-Cause Mortality, Stroke, and Cancer Incidence and Mortality in the Busselton Health Study Cohort

http://dx.doi.org/10.5664/jcsm.3600

Nathaniel S. Marshall, Ph.D.1,2; Keith K.H. Wong, MB.BS., Ph.D.1,3; Stewart R.J. Cullen, MB.BS.4; Matthew W. Knuiman, Ph.D.5; Ronald R. Grunstein, M.D., Ph.D.1,3
1NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; 2Sydney Nursing School, University of Sydney, Sydney, Australia; 3Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; 4Western Australian Sleep Disorders Research Institute, Perth, Australia; 5School of Population Health, University of Western Australia, Perth, Australia

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.

Commentary:

A commentary on this article appears in this issue on page 363.

Citation:

Marshall NS; Wong KK; Cullen SR; Knuiman MW; Grunstein RR. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton health study cohort. J Clin Sleep Med 2014;10(4):355-362.




Please login to continue reading the full article

Subscribers to JCSM get full access to current and past issues of the JCSM.

Login to JCSM

Not a subscriber?

Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership