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Original article
Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans
  1. Miklos Z Molnar1,
  2. Istvan Mucsi2,3,
  3. Marta Novak3,4,
  4. Zoltan Szabo5,6,
  5. Amado X Freire7,
  6. Kim M Huch8,
  7. Onyebuchi A Arah9,
  8. Jennie Z Ma10,
  9. Jun L Lu1,
  10. John J Sim11,
  11. Elani Streja12,
  12. Kamyar Kalantar-Zadeh12,
  13. Csaba P Kovesdy1,8
  1. 1Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  2. 2Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
  3. 3Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
  4. 4Department of Psychiatry, University Health Network, University of Toronto, Toronto, Canada
  5. 5Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, Linköping University Hospital, Linköping, Sweden
  6. 6Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  7. 7Pulmonary Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA
  8. 8Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA
  9. 9Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
  10. 10Division of Nephrology, University of Virginia, Charlottesville, Virginia, USA
  11. 11Kaiser Permanente, Los Angeles, California, USA
  12. 12Division of Nephrology, University of California, Irvine, California, USA
  1. Correspondence to Dr Miklos Z Molnar, Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, 956 Court Ave, Suite B216B, Memphis, TN 38163, USA; mzmolnar{at}uthsc.edu

Abstract

Rationale 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).

Objectives We hypothesised that a diagnosis of incident OSA is associated with higher risks of these adverse clinical outcomes.

Methods, measurements 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 m2, 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 m2, and (5) slopes of eGFR.

Main 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 m2 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.

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