All-cause mortality from obstructive sleep apnea in male and female patients with and without continuous positive airway pressure treatment: A registry study with 10 years of follow-up

Abstract

Background: More information is needed about the effect on mortality of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA), especially in women. Methods:We employed a historical cohort study design, using data from 25,389 patients with a diagnosis of OSA selected from the Danish National Patient Registry for the period 1999-2009. We used Cox proportional hazard function to evaluate the all-cause mortality from OSA in middle-aged and elderly males and females who were treated, or not, with CPAP. Results: Female OSA patients had a lower mortality than males, irrespective of whether they received CPAP treatment. CPAP treatment improved survival, as illustrated by the hazard ratio of 0.62 (P,0.001). This effect was dependent on gender: CPAP had no significant effect on 20-to 39-year-old males and females, but the overall mortality in this age group was small. Survival was increased by CPAP in 40-to 59-year-old and $60-year-old males, but no such effect was observed in females. Positive predictors of survival were young age, female gender, higher educational level, and low 3-year prior comorbidity as estimated by the Charlson Comorbidity Index. Negative predictors for survival were male gender, age $60 years, no CPAP treatment, prior comorbidity, and low educational level. Conclusion: CPAP therapy is associated with reduced all-cause mortality in middle-aged and elderly males, but no significant effect was found in females.

Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force

“…Further recent epidemiological reports with several hundred elderly subjects combined mainly contain data about the link between SDB in the elderly and a rapid cognitive decline [144][145][146]. One very recent article encompassing a registry of of >25 000 OSA patients in Denmark followed up over >10 years presented age-stratified data comparing the survival rate of PAP users to OSA patients who were, for various reasons, not treated with PAP [147]. The protective effect of PAP appeared particularly strong in older men >60 years of age.…”

Italian Association of Sleep Medicine (AIMS) position statement and guideline on the treatment of menopausal sleep disorders

“…On the other hand, Jennum et al [52], who reported a registry study with 10 years of follow-up, found that CPAP therapy was associated with reduced all-cause mortality in middle-aged and elderly men, but no significant effect was found in women. They showed that women with OSA had lower mortality rates than men, irrespective of whether or not they received CPAP treatment.…”

Mortality and morbidity in obstructive sleep apnoea–hypopnoea syndrome: results from a 30-year prospective cohort study

“…Previous cohort studies have shown female patients to have a lower morbidity and mortality rate than males [3,4]. CPAP has been shown to improve survival in male patients [5], but less so in females [4].…”

“…Severe obstructive sleep apnoea has been associated with a 1.9-times increased risk in all-cause mortality and 2.65-times increased risk of cardiovascular mortality [2]. Previous cohort studies have shown female patients to have a lower morbidity and mortality rate than males [3,4]. CPAP has been shown to improve survival in male patients [5], but less so in females [4].…”