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The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study

Ali Azarbarzin, Scott A Sands, Katie L Stone, Luigi Taranto-Montemurro, Ludovico Messineo, Philip I Terrill +6 more
European Heart Journal2018
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Published articlePublication date: Oct 30, 2018Added to atlas: Oct 15, 2026Source
Citations874Crossref referencesChecked Oct 16, 2026
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This study tested whether the 'hypoxic burden' of sleep apnoea, the respiratory event-associated area under the oxygen desaturation curve, predicts mortality better than the apnoea-hypopnoea index (AHI). In the MrOS cohort (2,743 men) and the Sleep Heart Health Study (5,111 adults), hypoxic burden strongly predicted cardiovascular mortality while the AHI did not. MrOS participants in the top two hypoxic-burden quintiles had hazard ratios of 1.81 and 2.73, and the top SHHS quintile had a hazard ratio of 1.96.

  • Signals: Respiration
  • Result: The samples were derived from two cohort studies: The Outcomes of Sleep Disorders in Older Men (MrOS), which included 2743 men, age 76.3 ± 5.5 years; and the Sleep Heart Health Study (SHHS), which included 5111 middle-aged and older adults (52.8% women),…
  • Result: Individuals in the MrOS study with hypoxic burden in the highest two quintiles had hazard ratios of 1.81 [95% confidence interval (CI) 1.25-2.62] and 2.73 (95% CI 1.71-4.36), respectively.
At a glance
Venue
European Heart Journal
Published
2018
DOI
10.1093/eurheartj/ehy624 (opens in a new tab)
arXiv
Not reported
PMID
30376054 (opens in a new tab)
Licence
Not reported
Signals
Not reported
Form factor
Not reported
Datasets
Subjects
2743 men
Code
Not reported
Added
Oct 15, 2026

Abstract

AimsApnoea-hypopnoea index (AHI), the universal clinical metric of sleep apnoea severity, poorly predicts the adverse outcomes of sleep apnoea, potentially because the AHI, a frequency measure, does not adequately capture disease burden. Therefore, we sought to evaluate whether quantifying the severity of sleep apnoea by the 'hypoxic burden' would predict mortality among adults aged 40 and older.Methods and resultsThe samples were derived from two cohort studies: The Outcomes of Sleep Disorders in Older Men (MrOS), which included 2743 men, age 76.3 ± 5.5 years; and the Sleep Heart Health Study (SHHS), which included 5111 middle-aged and older adults (52.8% women), age: 63.7 ± 10.9 years. The outcomes were all-cause and Cardiovascular disease (CVD)-related mortality. The hypoxic burden was determined by measuring the respiratory event-associated area under the desaturation curve from pre-event baseline. Cox models were used to calculate the adjusted hazard ratios for hypoxic burden. Unlike the AHI, the hypoxic burden strongly predicted CVD mortality and all-cause mortality (only in MrOS). Individuals in the MrOS study with hypoxic burden in the highest two quintiles had hazard ratios of 1.81 [95% confidence interval (CI) 1.25-2.62] and 2.73 (95% CI 1.71-4.36), respectively. Similarly, the group in the SHHS with hypoxic burden in the highest quintile had a hazard ratio of 1.96 (95% CI 1.11-3.43).ConclusionThe 'hypoxic burden', an easily derived signal from overnight sleep study, predicts CVD mortality across populations. The findings suggest that not only the frequency but the depth and duration of sleep related upper airway obstructions, are important disease characterizing features.

Verbatim fromEurope PMC· Abstract via Europe PMC; © the authors/publisher

The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study: ChatPPG research summary card

How it works

How Method works: Setup → Method → ResultSetup: Cohort (2743 men); Signals (Respiration). Method: Method. Result: Result (The samples were derived from two cohort studies: The Outcomes of Sleep Disorders in Older Men (MrOS), which included 2743 men, age 76.3 ± 5.5 years; and the Sleep Heart Health Study (SHHS), which included 5111 middle-aged and older adults (52.8% women),…); Result (Individuals in the MrOS study with hypoxic burden in the highest two quintiles had hazard ratios of 1.81 [95% confidence interval (CI) 1.25-2.62] and 2.73 (95% CI 1.71-4.36), respectively.).SetupCohort: 2743 menCohort2743 menSignals: RespirationSignalsRespirationMethodMethodResultResult: The samples were derived from two cohort studies: The Outcomes of Sleep Disorders in Older Men (MrOS), which included 2743 men, age 76.3 ± 5.5 years; and the Sleep Heart Health Study (SHHS), which included 5111 middle-aged and older adults (52.8% women),…ResultThe samples were derived from two…Result: Individuals in the MrOS study with hypoxic burden in the highest two quintiles had hazard ratios of 1.81 [95% confidence interval (CI) 1.25-2.62] and 2.73 (95% CI 1.71-4.36), respectively.ResultIndividuals in the MrOS study with…
Cohort
2743 men

Datasets used· 2

Dataset
MrOS Sleep Study (Osteoporotic Fractures in Men, NSRR)
psgECGEEGResp
Dataset
Sleep Heart Health Study (SHHS, NSRR)
psgECGEEGResp

Cite

@article{azarbarzinhypoxicburdenc2018,
  title = {{The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study}},
  author = {Ali Azarbarzin and Scott A Sands and Katie L Stone and Luigi Taranto-Montemurro and Ludovico Messineo and Philip I Terrill and Sonia Ancoli-Israel and Kristine Ensrud and Shaun Purcell and David P White and Susan Redline and Andrew Wellman},
  year = {2018},
  journal = {European Heart Journal},
  doi = {10.1093/eurheartj/ehy624}
}

History

  1. Added to the ChatPPG research hub

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