Journal
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
Volume 194, Issue 8, Pages 1007-1014Publisher
AMER THORACIC SOC
DOI: 10.1164/rccm.201511-2178OC
Keywords
sleep apnea; impaired lung function; mortality
Categories
Funding
- NHLBI [U01HL53940, U01HL53941, U01HL53938, U01HL53916, U01HL53934, U01HL53931, U01HL53937, U01HL64360, U01HL63463, U01HL63429]
- National Institutes of Health [K23-HL123594, R01 HL075078, R01 HL117167]
- Johns Hopkins University School of Medicine Clinician Scientist Award
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Rationale: Whether sleep-disordered breathing (SDB) severity and diminished lung function act synergistically to heighten the risk of adverse health outcomes remains a topic of significant debate. Objectives: The current study sought to determine whether the association between lower lung function and mortality would be stronger in those with increasing severity of SDB in a community based cohort of middle-aged and older adults. Methods: Full montage home sleep testing and spirometry data were analyzed on 6,173 participants of the Sleep Heart Health Study. Proportional hazards models were used to calculate risk for all-cause mortality, with FEV1 and apnea-hypopnea index (AHI) as the primary exposure indicators along with several potential confounders. Measurements and Main Results: All-cause mortality rate was 26.9 per 1,000 person-years in those with SDB (AHI events/h) and 18.2 per 1,000 person-years in those without (AHI <5 events/h). For every 200-ml decrease in FEV1, all-cause mortality increased by 11.0% in those without SDB (hazard ratio, 1.11; 95% confidence interval, 1.08-1.13). In contrast, for every 200-ml decrease in FEVI, all-cause mortality increased by only 6.0% in participants with SDB (hazard ratio, 1.06; 95% confidence interval, 1.04-1.09). Additionally, the incremental influence of lung function on all -cause mortality was less with increasing severity of SDB (P value for interaction between AHI and FEV1, 0.004). Conclusions: Lung function was associated with risk for all -cause mortality. The incremental contribution of lung function to mortality diminishes with increasing severity of SDB.
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