title: Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans.
abstract: BACKGROUND
  There is a paucity of large cohort studies examining the association of obstructive sleep apnoea (OSA) with clinical outcomes including all-cause mortality, coronary heart disease (CHD), strokes and chronic kidney disease (CKD).
  
  
  OBJECTIVE
  We hypothesised that a diagnosis of incident OSA is associated with higher risks of these adverse clinical outcomes.
  In a nationally representative cohort of over 3 million (n=3 079 514) US veterans (93% male) with baseline estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m(2), we examined the association between the diagnosis of incident OSA, treated and untreated with CPAP, and: (1) all-cause mortality, (2) incident CHD, (3) incident strokes, (4)incident CKD defined as eGFR<60 mL/min/1.73 m(2), and (5) slopes of eGFR.
  
  
  RESULTS
  Compared with OSA-negative patients, untreated and treated OSA was associated with 86% higher mortality risk, (adjusted HR and 95% CI 1.86 (1.81 to 1.91) and 35% (1.35 (1.21 to 1.51)), respectively. Similarly, untreated and treated OSA was associated with 3.5 times (3.54 (3.40 to 3.69)) and 3 times (3.06 (2.62 to 3.56)) higher risk of incident CHD; 3.5 times higher risk of incident strokes (3.48 (3.28 to 3.64) and 3.50 (2.92 to 4.19)) for untreated and treated OSA, respectively. The risk of incident CKD was also significantly higher in untreated (2.27 (2.19 to 2.36)) and treated (2.79 (2.48 to 3.13)) patients with OSA. The median (IQR) of the eGFR slope was -0.41 (-2.01 to 0.99), -0.61 (-2.69 to 0.93) and -0.87 (-3.00 to 0.70) mL/min/1.73 m(2) in OSA-negative patients, untreated OSA-positive patients and treated OSA-positive patients, respectively.
  
  
  CONCLUSIONS
  In this large and contemporary cohort of more than 3 million US veterans, a diagnosis of incident OSA was associated with higher mortality, incident CHD, stroke and CKD and with faster kidney function decline.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.affiliation: Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
authors.forename: Istvan
authors.initials: I
authors.lastname: Mucsi
authors.affiliation: Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary Department of Psychiatry, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Marta
authors.initials: M
authors.lastname: Novak
authors.affiliation: Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, Linköping University Hospital, Linköping, Sweden Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Szabo
authors.affiliation: Pulmonary Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA.
authors.forename: Amado X
authors.initials: AX
authors.lastname: Freire
authors.affiliation: Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Huch
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA.
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
authors.affiliation: Division of Nephrology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Jennie Z
authors.initials: JZ
authors.lastname: Ma
authors.affiliation: Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Jun L
authors.initials: JL
authors.lastname: Lu
authors.affiliation: Kaiser Permanente, Los Angeles, California, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Sim
authors.affiliation: Division of Nephrology, University of California, Irvine, California, USA.
authors.forename: Elani
authors.initials: E
authors.lastname: Streja
authors.affiliation: Division of Nephrology, University of California, Irvine, California, USA.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.affiliation: Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA.
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000401:mortality; D020521:Stroke / Q000150:complications* / Q000453:epidemiology; D016019:Survival Analysis; D014481:United States; D014728:Veterans