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Multicenter Study
. 2023 Dec 1;6(12):e2346085.
doi: 10.1001/jamanetworkopen.2023.46085.

Objective Sleep Duration and All-Cause Mortality Among People With Obstructive Sleep Apnea

Yiqi Lin  1 , Yongxi Wu  1 , Qianwen Lin  1 , Yun Kwok Wing  2   3 , Lili Xu  4 , Junbo Ge  4 , Qinwei Wu  1 , Zhen Li  1 , Qingjie Wu  1 , Beiwei Lin  1 , Shichao Wei  1
Affiliations
Multicenter Study

Objective Sleep Duration and All-Cause Mortality Among People With Obstructive Sleep Apnea

Yiqi Lin et al. JAMA Netw Open. .

Abstract

Importance: The association between sleep duration and all-cause mortality remains unclear among people with obstructive sleep apnea (OSA).

Objective: To explore whether there is an association between sleep duration and all-cause mortality among people with OSA.

Design, setting, and participants: This cohort study investigated participants with OSA from the Sleep Heart Health Study (SHHS) in which participants were enrolled between 1995 and 1998 with questionnaires and polysomnography (PSG) assessment and followed up for a median of 11.8 years. SHHS was a multicenter community-based study; 2574 participants with OSA defined by apnea-hypopnea index (AHI) greater than or equal to 15 from SHHS were found; all of them had all-cause mortality data and were included in the study. Data were analyzed from November 2022 to October 2023.

Exposures: Participants were divided into 4 groups with objective sleep duration of (1) at least 7 hours, (2) 6 to less than 7 hours, (3) 5 to less than 6 hours, and (4) less than 5 hours, which was determined by total sleep time on PSG at baseline.

Main outcomes and measures: All-cause mortality was defined as deaths from any cause and its risk was compared among 4 OSA groups using Cox regression models.

Results: A total of 2574 participants with OSA were included (1628 [63.2%] men and 946 [36.8%] women; mean [SD] age, 65.4 [10.7] years; 211 [8.2%] Black, 2230 [86.6%] White, 133 [5.2%] other race). Overall, 688 all-cause deaths were observed in participants. Compared with the group sleeping at least 7 hours, the groups sleeping 6 to less than 7 hours (hazard ratio [HR], 1.53 [95% CI, 1.13-2.07]), 5 to less than 6 hours (HR, 1.40 [95% CI, 1.03-1.90]), and less than 5 hours (HR, 1.64 [95% CI, 1.20-2.24]) had significantly higher risks of all-cause mortality independent of AHI. Sensitivity analyses were performed among participants with available data of positive airway pressure treatment during follow-up and the finding was mostly consistent, albeit the HR for the group of 5 to less than 6 hours was not statistically significant.

Conclusions and relevance: In this cohort study of 2574 participants with OSA, those with shorter objective sleep duration had higher risk of all-cause mortality independent of AHI compared with those sleeping at least 7 hours. Further studies would be needed to investigate health benefits of extending sleep length among people with OSA with short sleep duration.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Wing reported grants from Health and Medical Research Fund (reference No. 10210686, reference No. 18190931, reference No. 19201331, reference No. 09202766, reference No. 19202401, reference No. 09203066, reference No. 08190526, reference No. 18190471), grants from Research Grant Council (reference No. 14108722, reference No. 17615722, reference No. 15223822, reference No. C4061-21GF, reference No. C4044-21GF, reference No. 14111021, reference No. 14107821, reference No. 14115021, reference No. 17114921, reference No. 17613321), grants from The Chinese University of Hong Kong (reference No. 2022.071), nonfinancial support from Clinical Translational Catalyst Programme (member), and personal fees from Eisai China Inc (chair webinar) outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Unadjusted Kaplan-Meier Curves Across Groups With Different Objective Sleep Duration for All-Cause Mortality
Figure 2.
Figure 2.. Restricted Cubic Spline of Association Between Objective Sleep Duration and All-Cause Mortality
The association was adjusted for age; gender; race; smoking history; body mass index; history of diabetes, cardiovascular disease, hypertension, chronic obstructive pulmonary disease; usage of lipid-lowering medication and antidepressants within 2 weeks at baseline; and apnea-hypopnea index. The 95th percentile was used as the reference value. Shaded areas indicate 95% CIs.
See this image and copyright information in PMC

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