Influence of Lung Function and Sleep-disordered Breathing on All-Cause Mortality. A Community-based Study

Abstract

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 communitybased 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 FEV 1 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 >5 events/h) and 18.2 per 1,000 person-years in those without (AHI ,5 events/h). For every 200-ml decrease in FEV 1 , 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 FEV 1 , 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 FEV 1 , 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.

Predictive factors for COPD exacerbations and mortality in patients with overlap syndrome

“…Previous studies have suggested an inverse relationship between upper airway patency and the degree of hyperinflation . In a sample of 51 sleep apnoea patients derived from 10 192 smokers with and without emphysema from the COPDGene project who underwent high‐resolution chest‐computed tomography (CT) imaging and spirometry, Krachman and colleagues reported that CT‐derived per cent gas trapping was an important determinant for AHI.…”

Influence of lung function and sleep‐disordered breathing on stroke: a community‐based study

“…However, Putcha et al . demonstrated that the incremental contribution of lung function to mortality is attenuated with increasing SDB severity . The aim of this study was to investigate the influence of impaired lung function on incident stroke in a population of individuals with and without SDB from the Sleep Heart Health Study (SHHS), a large community‐based perspective cohort.…”

“…synergistic effect promotes the activation of the sympathetic nervous system, oxidative stress and systemic inflammation, which collectively contribute to vascular injuries and cardio-cerebral vascular incidents [3]. However, Putcha et al demonstrated that the incremental contribution of lung function to mortality is attenuated with increasing SDB severity [10]. The aim of this study was to investigate the influence of impaired lung function on incident stroke in a population of individuals with and without SDB from the Sleep Heart Health Study (SHHS), a large community-based perspective cohort.…”

Sex, stress and sleep apnoea: Decreased susceptibility to upper airway muscle dysfunction following intermittent hypoxia in females

“…Sleep apnoea is an independent risk factor for premature death (Putcha et al, 2016), with a wealth of evidence pointing to OSAS-related cardio-metabolic and neurocognitive dysfunction (McNicholas et al, 2007;Younes & White, 2012).…”