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Sleep-Disordered Breathing and Mortality: A Prospective Cohort Study

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dc.contributor.author Punjabi, Naresh M. en_US
dc.contributor.author Caffo, Brian S. en_US
dc.contributor.author Goodwin, James L. en_US
dc.contributor.author Gottlieb, Daniel J. en_US
dc.contributor.author Newman, Anne B. en_US
dc.contributor.author O'Connor, George T. en_US
dc.contributor.author Rapoport, David M. en_US
dc.contributor.author Redline, Susan en_US
dc.contributor.author Resnick, Helaine E. en_US
dc.contributor.author Robbins, John A. en_US
dc.contributor.author Shahar, Eyal en_US
dc.contributor.author Unruh, Mark L. en_US
dc.contributor.author Samet, Jonathan M. en_US
dc.date.accessioned 2012-01-09T21:00:18Z
dc.date.available 2012-01-09T21:00:18Z
dc.date.issued 2009-8-18 en_US
dc.identifier.citation Punjabi, Naresh M., Brian S. Caffo, James L. Goodwin, Daniel J. Gottlieb, Anne B. Newman, George T. O'Connor, David M. Rapoport, Susan Redline, Helaine E. Resnick, John A. Robbins, Eyal Shahar, Mark L. Unruh, Jonathan M. Samet. "Sleep-Disordered Breathing and Mortality: A Prospective Cohort Study" PLoS Medicine 6(8):e1000132. (2009) en_US
dc.identifier.issn 1549-1676 en_US
dc.identifier.uri http://hdl.handle.net/2144/2964
dc.description.abstract In a cohort of 6,441 volunteers followed over an average of 8.2 years, Naresh Punjabi and colleagues find sleep-disordered breathing to be independently associated with mortality and identify predictive characteristics. BACKGROUND. Sleep-disordered breathing is a common condition associated with adverse health outcomes including hypertension and cardiovascular disease. The overall objective of this study was to determine whether sleep-disordered breathing and its sequelae of intermittent hypoxemia and recurrent arousals are associated with mortality in a community sample of adults aged 40 years or older. METHODS AND FINDINGS. We prospectively examined whether sleep-disordered breathing was associated with an increased risk of death from any cause in 6,441 men and women participating in the Sleep Heart Health Study. Sleep-disordered breathing was assessed with the apnea–hypopnea index (AHI) based on an in-home polysomnogram. Survival analysis and proportional hazards regression models were used to calculate hazard ratios for mortality after adjusting for age, sex, race, smoking status, body mass index, and prevalent medical conditions. The average follow-up period for the cohort was 8.2 y during which 1,047 participants (587 men and 460 women) died. Compared to those without sleep-disordered breathing (AHI: >5 events/h), the fully adjusted hazard ratios for all-cause mortality in those with mild (AHI: 5.0–14.9 events/h), moderate (AHI: 15.0–29.9 events/h), and severe (AHI: ≥30.0 events/h) sleep-disordered breathing were 0.93 (95% CI: 0.80–1.08), 1.17 (95% CI: 0.97–1.42), and 1.46 (95% CI: 1.14–1.86), respectively. Stratified analyses by sex and age showed that the increased risk of death associated with severe sleep-disordered breathing was statistically significant in men aged 40–70 y (hazard ratio: 2.09; 95% CI: 1.31–3.33). Measures of sleep-related intermittent hypoxemia, but not sleep fragmentation, were independently associated with all-cause mortality. Coronary artery disease–related mortality associated with sleep-disordered breathing showed a pattern of association similar to all-cause mortality. CONCLUSIONS. Sleep-disordered breathing is associated with all-cause mortality and specifically that due to coronary artery disease, particularly in men aged 40–70 y with severe sleep-disordered breathing. en_US
dc.description.sponsorship National Heart, Lung, and Blood Institute (U01-HL53940, U01-HL53941 U01-HL63463, U01-HL53937, U01-HL53938, U01-HL53916, U01-HL53934, U01-HL63429, U01-HL53931) en_US
dc.language.iso en en_US
dc.publisher Public Library of Science en_US
dc.rights Copyright Punjabi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_US
dc.title Sleep-Disordered Breathing and Mortality: A Prospective Cohort Study en_US
dc.type article en_US
dc.identifier.doi 10.1371/journal.pmed.1000132 en_US
dc.identifier.pubmedid 19688045 en_US
dc.identifier.pmcid 2722083 en_US


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