Do Patients with Sleep Apnea Die in Their Sleep?

doi:10.1378/chest.94.3.531

Chest

Volume 94, Issue 3, September 1988, Pages 531-538

https://doi.org/10.1378/chest.94.3.531 Get rights and content

Patients with sleep apnea syndrome (SAS) show cardiac dysrhythmias in association with cyclical nocturnal hypoxemia; are they at risk of dying during sleep? To assess this claim, we reviewed the clinical course of 91 patients with polysomnographically documented SAS between July 1978 and June 1986. A control group was comprised of 35 patients who were referred with symptoms suggestive of SAS but had negative sleep studies. Follow-up was obtained by survey questionnaire. Nine of 91 SAS and four of 35 control patients had died by completion of the study. There were no statistically significant differences in mortality between the two groups. None of the SAS patients died in their sleep, but they reported a higher incidence of disability and vehicular mishaps than did control subjects. The findings in this study do not support the hypothesis that SAS patients are at increased risk of dying in their sleep. (Chest 1988; 94:531-38)

Section snippets

Type of Study

This was an observational retrospective study of all adult patients who, because of symptoms suggestive of SAS, were referred to the University of Florida Shands Teaching Hospital or the Veterans Administration Medical Center, Gainesville, FL, for polysomnography for the eight-year span between July 1978 and June 1986.

Patient Population

The patients were generally referred by outside physicians. All patients were randomly distributed to the pulmonary clinics at both hospitals and were evaluated by one of eight

RESULTS

As of February 1987, follow-up information was available on all 126 patients. Over 60 percent of the surveys mailed were returned completed. The remainder were generally returned unopened as a result of change of address, etc. Of surveys returned by patients, only one declined to complete it. (Although the questionnaire was not completed, that the patient returned it verified that he was still alive, and allowed inclusion in the mortality analysis.) Of those patients who never received surveys,

DISCUSSION

Despite the fact that all SAS patients had a strikingly higher incidence of episodic oxygen desaturation associated with sleep-disordered breathing events and significantly greater awake and asleep electrocardiographic abnormalities than the control patients, overall mortality did not differ between SAS patients and control subjects. Specifically, no patient with SAS died during sleep, whereas three of the control group patients did.

Two patients in the control group had severe underlying

CONCLUSION

The findings in our study point out several important issues: (1) SAS causes significant morbidity. (2) Whereas patients with SAS may exhibit disturbingly severe arterial desaturation and associated dysrhythmias, the clinical impression extracted from this series would suggest that nocturnal sudden death is not as imminent in these patients as our clinical intuition might have previously led us to believe. Therefore, the urgency, timing, and indications for aggressive therapeutic interventions

ACKNOWLEDGMENTS

The authors wish to acknowledge the assistance of Don Hellard and Ian McLeod of the polysomnography laboratories at the University of Florida and GVAMC, of Cindy Ireland, of Anne Crawford in the typing of the manuscript, and of Janet Wootten for her editorial expertise.

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We examined 136 patients who underwent overnight polysomnography together with 24-h Holter electrocardiography and who were diagnosed as having OSA [apnea–hypopnea index (AHI) ≥5]. The patients were divided into the following 3 groups: 30 with 5≤ AHI <15 (group A); 33 with 15≤ AHI <30 (group B); 73 with AHI ≥30 (group C). Mean HRs during 24 h, wakefulness, and sleep were calculated.
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IGM was observed in 78 (60.5%) patients: DM in 39 (30.2%) and IGT in 39 (30.2%). The frequency of IGM was significantly different among patients with AHI ≥30, those with 15 ≤ AHI < 30, and those with AHI <15 (72.1%; 53.7%; 35.0%; respectively, p = 0.001). Univariate logistic regression analyses showed male sex, the BMI, the AHI, and the lowest SpO₂ to be significantly associated with IGM. A stepwise multivariate logistic regression analysis showed a male sex and the AHI to be independently associated with IGM.
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Citation Excerpt :
This could bias our study population. However, there is no evidence to suggest that the study is biased in terms of the ratio of men to women that we discharged with CPAP since this was similar to the ratio of men and women diagnosed with OSA in previous samples 6,18,19 and in our experience proportionally fewer women are referred for sleep studies. Unlike some previous studies of mortality in OSA3,18,19 we were able to identify deaths amongst patients who had stopped using CPAP giving a true mortality rate of the men and women in our study sample for comparison.
The study aim was to compare the mortality risk of men and women diagnosed with obstructive sleep apnoea (OSA) and started on treatment with continuous positive airway pressure (CPAP).
From August to December 2003 we reviewed the hospital records of patients who had started on CPAP for OSA between July 1995 and June 1998. Mortality rates were compared between men and women. Associations with mortality risk were determined using univariate and multivariate Cox's proportional hazards regression.
The sample comprised 292 men and 47 women. Eight percent of the men and 23% of the women died (p = 0.003). Univariate analysis showed increased mortality risk was associated with female sex, greater age when CPAP was started, a pre-treatment minimum nocturnal oxygen saturation (SpO₂) <75%, a higher Charlson comorbidity index score and discontinuation of CPAP treatment. Female sex remained associated with increased mortality independent of age, minimum SpO₂ and CPAP use, but was not independent of the Charlson score.
Women diagnosed with OSA and treated with CPAP demonstrated a 3.44 greater mortality risk than men, mostly due to greater comorbidity.
Arrhythmias in patients with obstructive sleep apnea
2008, Sleep Medicine

View all citing articles on Scopus

Supported by funds from the Research Service, Veterans Administration Medical Center, Gainesville, FL.

Manuscript received December 21; revision accepted March 8.

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Chest

Do Patients with Sleep Apnea Die in Their Sleep?

Section snippets

Type of Study

Patient Population

RESULTS

DISCUSSION

CONCLUSION

ACKNOWLEDGMENTS

Am J Med

JAMA

Am J Cardiol

Am J Med

Am J Med

Chest

Sleep apnea and related disorders

Disease-a-Month

Clinical overview of the sleep apnea syndromes

Serious complications and sudden death in the Pickwickian syndrome

Hopkins Med J

Oximeter studies on patients with chronic obstructive emphysema awake and during sleep

N Engl J Med

Respiratory function during sleep in patients with chronic obstructive lung disease

J Clin Invest

Continuous in-vivo monitoring of arterial oxygenation in chronic obstructive lung disease

Arch Intern Med

Nocturnal vs. diurnal cardiac arrhythmias in patients with chronic obstructive pulmonary disease

Chest