Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans.

Publisher: British Medical Assn Country of Publication: England NLM ID: 0417353 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-3296 (Electronic) Linking ISSN: 00406376 NLM ISO Abbreviation: Thorax Subsets: MEDLINE

Original Publication: London : British Medical Assn.

Coronary Disease/*complications ; Renal Insufficiency, Chronic/*complications ; Sleep Apnea, Obstructive/*complications ; Stroke/*complications; Aged ; Cohort Studies ; Coronary Disease/epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Renal Insufficiency, Chronic/epidemiology ; Risk Factors ; Sleep Apnea, Obstructive/mortality ; Stroke/epidemiology ; Survival Analysis ; United States ; Veterans

Rationale: There is a paucity of large cohort studies examining the association of obstructive sleep apnoea (OSA) with clinical outcomes including all-cause mortality, coronary heart disease (CHD), strokes and chronic kidney disease (CKD).
Objectives: We hypothesised that a diagnosis of incident OSA is associated with higher risks of these adverse clinical outcomes.
Methods, Measurements: In a nationally representative cohort of over 3 million (n=3 079 514) US veterans (93% male) with baseline estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m(2), we examined the association between the diagnosis of incident OSA, treated and untreated with CPAP, and: (1) all-cause mortality, (2) incident CHD, (3) incident strokes, (4)incident CKD defined as eGFR<60 mL/min/1.73 m(2), and (5) slopes of eGFR.
Main Results: Compared with OSA-negative patients, untreated and treated OSA was associated with 86% higher mortality risk, (adjusted HR and 95% CI 1.86 (1.81 to 1.91) and 35% (1.35 (1.21 to 1.51)), respectively. Similarly, untreated and treated OSA was associated with 3.5 times (3.54 (3.40 to 3.69)) and 3 times (3.06 (2.62 to 3.56)) higher risk of incident CHD; 3.5 times higher risk of incident strokes (3.48 (3.28 to 3.64) and 3.50 (2.92 to 4.19)) for untreated and treated OSA, respectively. The risk of incident CKD was also significantly higher in untreated (2.27 (2.19 to 2.36)) and treated (2.79 (2.48 to 3.13)) patients with OSA. The median (IQR) of the eGFR slope was -0.41 (-2.01 to 0.99), -0.61 (-2.69 to 0.93) and -0.87 (-3.00 to 0.70) mL/min/1.73 m(2) in OSA-negative patients, untreated OSA-positive patients and treated OSA-positive patients, respectively.
Conclusions: In this large and contemporary cohort of more than 3 million US veterans, a diagnosis of incident OSA was associated with higher mortality, incident CHD, stroke and CKD and with faster kidney function decline.
(Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

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R01 DK096920 United States DK NIDDK NIH HHS; SDR 02-237 United States HX HSRD VA; 1R01DK096920 United States DK NIDDK NIH HHS

Date Created: 20150604 Date Completed: 20151105 Latest Revision: 20240610

20240610

PMC4575815

10.1136/thoraxjnl-2015-206970

26038534