title: Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort.
abstract: OBJECTIVE
  To ascertain whether objectively measured obstructive sleep apnea (OSA) independently increases the risk of all cause death, cardiovascular disease (CVD), coronary heart disease (CHD), stroke or cancer.
  
  
  METHODS
  Community-based cohort.
  
  
  METHODS
  400 residents of the Western Australian town of Busselton.
  
  
  METHODS
  OSA severity was quantified via the respiratory disturbance index (RDI) as measured by a single night recording in November-December 1990 using the MESAM IV device, along with a range of other risk factors. Follow-up for deaths and hospitalizations was ascertained via record linkage to the end of 2010.
  
  
  RESULTS
  We had follow-up data in 397 people and then removed those with a previous stroke (n = 4) from the mortality/ CVD/CHD/stroke analyses and those with cancer history from the cancer analyses (n = 7). There were 77 deaths, 103 cardiovascular events (31 strokes, 59 CHD) and 125 incident cases of cancer (39 cancer fatalities) during 20 years follow-up. In fully adjusted models, moderate-severe OSA was significantly associated with all-cause mortality (HR = 4.2; 95% CI 1.9, 9.2), cancer mortality (3.4; 1.1, 10.2), incident cancer (2.5; 1.2, 5.0), and stroke (3.7; 1.2, 11.8), but not significantly with CVD (1.9; 0.75, 4.6) or CHD incidence (1.1; 0.24, 4.6). Mild sleep apnea was associated with a halving in mortality (0.5; 0.27, 0.99), but no other outcome, after control for leading risk factors.
  
  
  CONCLUSIONS
  Moderate-to-severe sleep apnea is independently associated with a large increased risk of all-cause mortality, incident stroke, and cancer incidence and mortality in this community-based sample.
authors.affiliation: NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia ; Sydney Nursing School, University of Sydney, Sydney, Australia.
authors.forename: Nathaniel S
authors.initials: NS
authors.lastname: Marshall
authors.affiliation: NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia ; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Keith K H
authors.initials: KK
authors.lastname: Wong
authors.affiliation: Western Australian Sleep Disorders Research Institute, Perth, Australia.
authors.forename: Stewart R J
authors.initials: SR
authors.lastname: Cullen
authors.affiliation: School of Population Health, University of Western Australia, Perth, Australia.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Knuiman
authors.affiliation: NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia ; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Ronald R
authors.initials: RR
authors.lastname: Grunstein
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000401:mortality*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D014904:Western Australia / Q000453:epidemiology
keywords: Sleep disordered breathing; coronary artery disease; melanoma
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