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Mediation effect of hypoxia in the relationship between obstructive sleep apnea and cardiovascular death risk

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

This study aimed to explore the role of hypoxia in the relationship between obstructive sleep apnea (OSA) and cardiovascular disease (CVD) death risk based on data from the Sleep Heart Health Study (SHHS).

Methods

Multivariate logistic regression analysis was used to analyze the association between OSA, hypoxia, and CVD death risk. Causal mediation analysis was performed to assess the role of hypoxia. The severity of OSA was evaluated by the apnea–hypopnea index (AHI), and the hypoxia was quantified by the percentage of sleep time with less than 90% oxygen saturation (PCTST90).

Results

Of these 5,145 participants, 989 had no OSA, 2,110 had mild OSA, and 2,046 had moderate-to-severe OSA. After adjusting all confounders, mild OSA [odds ratio (OR): 1.800; 95% confidence interval (CI), 1.192–2.802], moderate-to-severe OSA (OR: 1.745; 95%CI, 1.148–2.758), 0 < PCTST90 < 1 (OR: 1.668; 95%CI, 1.184–2.385), and PCTST90 ≥ 1 (OR: 1.649; 95%CI, 1.148–2.400) were associated with an increased death risk of CVD. Furthermore, participants with mild OSA (OR: 3.742; 95%CI, 3.183–4.398) and moderate-to-severe OSA (OR: 19.671; 95%CI, 16.303–23.734) had a higher risk of hypoxia than those without OSA. Causal mediation analysis indicated that the average direct effect (ADM) of moderate-to-severe OSA and average causal mediation effect (ACME) of hypoxia on CVD death risk were 0.024 (95%CI, 0.004–0.040) and 0.013 (95%CI, 0.005–0.020), respectively, and the average mediating effect ratio was 33.94%.

Conclusion

Hypoxia played a mediating role in the increased death risk of CVD caused by OSA, and the mediating effect of hypoxia did not account for a large proportion.

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Data availability

The dataset is available on request of corresponding author.

Abbreviations

SHHS:

Sleep Heart Health Study

AHI:

Apnea–hypopnea index

PCTST90:

90% Oxygen saturation

OR:

Odds ratio

CI:

Confidence interval

ADM:

Average direct effect

ACME:

Average causal mediation effect

OSA:

Obstructive sleep apnea

CVD:

Cardiovascular diseases

HF:

Heart failure

BMI:

Body mass index

MI:

Myocardial infarction

COPD:

Chronic obstructive pulmonary disease

LIPID:

Lipid-lowering medication

ACME:

Average causal mediation effect; SD: standard deviation

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Authors and Affiliations

  1. Department of Pulmonary and Critical Care Medicine, Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, People’s Republic of China

    Yan Zhou, Xiqing Tan, Junjuan Lu & Chun Liu

Authors
  1. Yan Zhou
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  2. Xiqing Tan
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  3. Junjuan Lu
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  4. Chun Liu
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Contributions

YZ and CL designed the study. YZ wrote the manuscript. XQT and JJL collected, analyzed, and interpreted the data. CL critically reviewed, edited, and approved the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Chun Liu.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This research analyzed de-identified information downloaded from the SHHS, which is exempt from future Institutional Review Board approval.

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All authors declare that they have seen and approved the final version of the manuscript.

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Zhou, Y., Tan, X., Lu, J. et al. Mediation effect of hypoxia in the relationship between obstructive sleep apnea and cardiovascular death risk. Sleep Breath 26, 1729–1737 (2022). https://doi.org/10.1007/s11325-022-02564-8

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  • DOI: https://doi.org/10.1007/s11325-022-02564-8

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