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



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 community-based cohort of middle-aged and older adults.



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 FEV1and apnea-hypopnea index (AHI) as the primary exposure indicators along with several potential confounders.



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 FEV1, 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 FEV1, 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 FEV1, 0.004).



Lung function was associated with risk for all-cause mortality. The incremental contribution of lung function to mortality diminishes with increasing severity of SDB.
1 Johns Hopkins University, Baltimore, Maryland.
Nirupama
N
Putcha
1 Johns Hopkins University, Baltimore, Maryland.
Ciprian
C
Crainiceanu
1 Johns Hopkins University, Baltimore, Maryland.
Gina
G
Norato
2 University of Southern California, Los Angeles, California.
Jonathan
J
Samet
3 University of Arizona, Tucson, Arizona.|4 Brigham and Women's Hospital and.
Stuart F
SF
Quan
4 Brigham and Women's Hospital and.|5 VA Boston Healthcare System, Boston, Massachusetts.
Daniel J
DJ
Gottlieb
4 Brigham and Women's Hospital and.|6 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and.
Susan
S
Redline
1 Johns Hopkins University, Baltimore, Maryland.
Naresh M
0000-0003-1701-1550
NM
Punjabi
D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000401:mortality* / Q000503:physiopathology; D013147:Spirometry
impaired lung function; mortality; sleep apnea