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Volume 10 No. 04
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Accepted Papers

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

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


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


Community-based cohort

Setting and Participants:

400 residents of the Western Australian town of Busselton


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.


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.


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.


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


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.

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