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Corresponding author's email: miangel@comv.esNon-treated severe obstructive sleep apnea (OSA) has been proposed as a risk factor for mortality, and continuous positive Background. airway pressure (CPAP) has been shown to be an effective treatment for reducing this excess of mortality. However, the vast majority of studies have been performed on middle-aged male patients. Our objetive was to analyse the impact of OSA and CPAP treatment on long-term all-cause and cardiovascular mortality in a large cohort of elderly patients.Multicenter observational study of 939 consecutive elderly (≥65 years) subjects referred to the sleep laboratory for OSA Methods. suspicion between 1999-2007 and followed-up until December-2009. Four groups were established: 1. Control group without OSA (apnea-hypopnea index [AHI] <15), (n=160); 2. Mild-moderate OSA without (or non-compliant with) CPAP treatment (AHI 16-29), (n=104); 3. Severe OSA (AHI ≥30) without (or non-compliant with) CPAP treatment, (n=170), and 4. OSA of any severity with adequate (more than 3 hours/day) CPAP treatment, (n=505). Complete general, anthropometric, sleep study and cardiovascular or respiratory history data were recorded at the time of the sleep study. Mortality and its causes were obtained from death certificates. Fatal cardiovascular events included sudden death, stroke, heart failure (HF), cardiac arrhytmias and ischemic heart disease (IHD) Full-adjusted (age, sex, . cardiovascular risk factors, Epworth test, center of procedence, previous lung disease and oxygen saturation) Cox proportional analysis was used to identify independent risk factors for all-cause, malignant, cardiovascular, stroke, HF and IHD mortality.Mean age was 70.6 years (64.7% males). Median follow-up: 69 months. Mean apnea-hypopnea index (AHI): 42.2 and body mass Results. index (BMI): 34.4 Kg/m . During follow-up, 191 (20%) subjects died (101 cardiovascular; [28 strokes; 32 IHD; 38 HF]; 38 malignant disease 2and 52 from other causes). Figure 1 shows that non-treated severe OSA (but not non-treated mild-moderate OSA) was independently associated with all-cause and cardiovascular mortality (Figure 2 for cardiovascular mortality), as well as stroke and HF mortality, but not with IHD or malignant mortality. CPAP treatment reduced this excess of mortality in OSA patients. The presence of OSA symptoms (hypersomnolence) was not related to an increased risk of any cause of mortality in elderly patients. In elderly patients, severe non-treated OSA is a risk factor for all-cause and cardiovascular mortality. Within the Conclusions. cardiovascular sphere, severe non-treated OSA increases the risk of stroke and HF mortality but not of IHD mortality. Treatment with CPAP was effective in normalizing this excess of mortality. Figure 1Figure 2