Skip to main content

Advertisement

SpringerLink
Log in

Adequate continuous positive airway pressure therapy reduces mortality in Chinese patients with obstructive sleep apnea

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Background

Severe obstructive sleep apnea (OSA) is a risk factor for mortality. The ability of continuous positive airway pressure (CPAP) therapy to mitigate this increased risk of death has not been studied in Chinese adults. The objective of our study was to compare mortality in Chinese patients with simple snoring, untreated OSA, and OSA treated with CPAP.

Methods

We recruited adults with OSA or simple snoring from our sleep medicine clinic. OSA was diagnosed using standard polysomnography. Subjects were followed at least annually for a mean of 8.9 years (SD 1.9). CPAP compliance was checked with the built-in meter. We then assessed all-cause mortality.

Results

Five hundred fifty simple snorers, 257 with untreated mild OSA, 316 with untreated moderate OSA, 457 with untreated severe OSA, and 235 with mild to severe OSA treated with CPAP were included. Simple snorers had a much lower mortality rate (2.98 per 1000 person-years [95 % CI, 2.93 to 3.02]) than the untreated severe OSA group (11.07 per 1000 person-years [95 %CI, 10.86 to 11.29]; P < 0.0001). Compared with simple snorers, fully adjusted mortality was highest in the untreated, severe OSA group (hazard ratio [HR], 3.51 [95 %CI, 1.93 to 6.39]). Treatment of severe OSA patients with CPAP eliminated this increase in mortality (HR, 0.81[95 %CI, 0.36–1.86]).

Conclusions

Severe OSA significantly markedly increases the risk of death in Chinese patients and CPAP treatment with adequate compliance reduces this risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235

    Article  CAS  PubMed  Google Scholar 

  2. Young T, Finn L, Peppard PE et al (2008) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31(8):1071–1078

    PubMed Central  PubMed  Google Scholar 

  3. Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR (2008) Sleep apnea as an independent risk factor for all-cause mortality: the Busselton health study. Sleep 31(8):1079–1085

    PubMed Central  PubMed  Google Scholar 

  4. Punjabi NM, Caffo BS, Goodwin JL et al (2009) Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 6(8):e1000132

    Article  PubMed Central  PubMed  Google Scholar 

  5. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053

    Article  PubMed  Google Scholar 

  6. Shah NA, Yaggi HK, Concato J, Mohsenin V (2010) Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death. Sleep Breathing 14(2):131–136

    Article  PubMed  Google Scholar 

  7. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353(19):2034–2041

    Article  CAS  PubMed  Google Scholar 

  8. Campos-Rodriguez F, Martinez-Garcia MA, de la Cruz-Moron I, Almeida-Gonzalez C, Catalan-Serra P, Montserrat JM (2012) Cardiovascular mortality in women with obstructive sleep apnea with or without continuous positive airway pressure treatment: a cohort study. Ann Intern Med 156(2):115–122

    Article  PubMed  Google Scholar 

  9. Doherty LS, Kiely JL, Swan V, McNicholas WT (2005) Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome. Chest 127(6):2076–2084

    Article  PubMed  Google Scholar 

  10. Campos-Rodriguez F, Pena-Grinan N, Reyes-Nunez N et al (2005) Mortality in obstructive sleep apnea-hypopnea patients treated with positive airway pressure. Chest 128(2):624–633

    Article  PubMed  Google Scholar 

  11. Buchner NJ, Sanner BM, Borgel J, Rump LC (2007) Continuous positive airway pressure treatment of mild to moderate obstructive sleep apnea reduces cardiovascular risk. Am J Respir Crit Care Med 176(12):1274–1280

    Article  PubMed  Google Scholar 

  12. Wright J, Johns R, Watt I, Melville A, Sheldon T (1997) Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence. BMJ 314(7084):851–860

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Wang H, Parker JD, Newton GE et al (2007) Influence of obstructive sleep apnea on mortality in patients with heart failure. J Am Coll Cardiol 49(15):1625–1631

    Article  PubMed  Google Scholar 

  14. Barbe F, Duran-Cantolla J, Sanchez-de-la-Torre M et al (2012) Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA 307(20):2161–2168

    Article  CAS  PubMed  Google Scholar 

  15. Sanchez-de-la-Torre M, Campos-Rodriguez F, Barbe F (2013) Obstructive sleep apnoea and cardiovascular disease. Lancet Respir Med 1(1):61–72

    Article  PubMed  Google Scholar 

  16. Bradley TD, Floras JS (2009) Obstructive sleep apnoea and its cardiovascular consequences. Lancet 373(9657):82–93

    Article  PubMed  Google Scholar 

  17. Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. In: US Government Printing Office, US Public Health Service

  18. (1993) The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med 153(2):154–83

  19. Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165(9):1217–1239

    Article  PubMed  Google Scholar 

  20. Meoli AL, Casey KR, Clark RW et al (2001) Hypopnea in sleep-disordered breathing in adults. Sleep 24(4):469–470

    CAS  PubMed  Google Scholar 

  21. Cox DR (1972) Regression models and life tables. JR Stat Soc B 34(2):187–220

    Google Scholar 

  22. Lavie P, Lavie L, Herer P (2005) All-cause mortality in males with sleep apnoea syndrome: declining mortality rates with age. Eur Respir J 25(3):514–520

    Article  CAS  PubMed  Google Scholar 

  23. Veale D, Chailleux E, Hoorelbeke-Ramon A et al (2000) Mortality of sleep apnoea patients treated by nasal continuous positive airway pressure registered in the ANTADIR observatory. Association Nationale pour le Traitement A Domicile de l’Insuffisance Respiratoire chronique. Eur Respir J 15(2):326–331

    Article  CAS  PubMed  Google Scholar 

  24. Martinez-Garcia MA, Soler-Cataluna JJ, Ejarque-Martinez L et al (2009) Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med 180(1):36–41

    Article  PubMed  Google Scholar 

  25. Sahlin C, Sandberg O, Gustafson Y et al (2008) Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. Arch Intern Med 168(3):297–301

    Article  PubMed  Google Scholar 

  26. Gami AS, Howard DE, Olson EJ, Somers VK (2005) Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med 352(12):1206–1214

    Article  CAS  PubMed  Google Scholar 

  27. Peker Y, Hedner J, Kraiczi H, Loth S (2000) Respiratory disturbance index: an independent predictor of mortality in coronary artery disease. Am J Respir Crit Care Med 162(1):81–86

    Article  CAS  PubMed  Google Scholar 

  28. (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22(5):667–89

  29. Young T, Peppard P, Palta M et al (1997) Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 157(15):1746–1752

    Article  CAS  PubMed  Google Scholar 

  30. Benson K, Hartz AJ (2000) A comparison of observational studies and randomized, controlled trials. N Engl J Med 342(25):1878–1886

    Article  CAS  PubMed  Google Scholar 

  31. Concato J, Shah N, Horwitz RI (2000) Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med 342(25):1887–1892

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Glaab T, Vogelmeier C, Buhl R (2010) Outcome measures in chronic obstructive pulmonary disease (COPD): strengths and limitations. Respir Res 11:79

    Article  PubMed Central  PubMed  Google Scholar 

  33. Cazzola M, MacNee W, Martinez FJ et al (2008) Outcomes for COPD pharmacological trials: from lung function to biomarkers. Eur Respir J 31(2):416–469

    Article  CAS  PubMed  Google Scholar 

  34. Tashkin DP, Celli B, Senn S et al (2008) A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med 359(15):1543–1554

    Article  CAS  PubMed  Google Scholar 

  35. Calverley PM, Anderson JA, Celli B et al (2007) Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 356(8):775–789

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank the numerous participants, the collaborating clinicians, and the research staff involved throughout the study.

Conflict of interest

We declare that we have no financial or personal relationships that can inappropriately influence this work. There are no professional or other personal interests of any nature in any product, service and/or company that could be construed as influencing the content of this manuscript. The paper has not been presented at any conference.

Funding

This study was supported by the Capital Health Research and Development of Special Grants (2011-2003-05), National Natural Science Foundation of China (81271062), and the Beijing Municipal Natural Science Foundation (3500–11320005).

Author information

Authors and Affiliations

  1. Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, No. 2nd, Anzhen Road, Beijing, 100029, China

    Xiandao Yuan, Jugao Fang, Li Wang, Linyin Yao, Xiaojun Zhan, Hao Wu & Yongxiang Wei

  2. Beijing Tongren Hospital, Capital Medical University, Beijing, China

    Jugao Fang

  3. Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

    Li Li

  4. The University of Chicago Medicine, Chicago, IL, USA

    Jayant M. Pinto

Authors
  1. Xiandao Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jugao Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Li Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Linyin Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Li Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaojun Zhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hao Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jayant M. Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yongxiang Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yongxiang Wei.

Appendix

Appendix

Fig. 3
figure 3

Study flow diagram, intention-to-treat analysis. OSA obstructive sleep apnea-hypopnea, AHI apnea-hypopnea index, CPAP continuous positive airway pressure; CPAP patient declined to use CPAP, PSG polysomnography, ESS Epworth Sleepiness Scale

Full size image
Table 5 Variable associated with death in adjusted multivariated Cox regression analysis
Full size table
Table 6 Variable associated with death in adjusted multivariated Cox regression analysis, intention-to-treat analysis
Full size table
Table 7 Variable associated with death in 624 patients who began CPAP treatment
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yuan, X., Fang, J., Wang, L. et al. Adequate continuous positive airway pressure therapy reduces mortality in Chinese patients with obstructive sleep apnea. Sleep Breath 19, 911–920 (2015). https://doi.org/10.1007/s11325-014-1091-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-014-1091-9

Keywords

Search

Navigation