Short Sleep Duration Linked With All-Cause Mortality in Patients With Sleep Apnea

A recent cohort study within the Sleep Heart Health Study (SHHS) identified a significant association between sleep duration and all-cause mortality among individuals grappling with obstructive sleep apnea (OSA). The extensive investigation, spanning over 11.8 years, explored the relationship between the length of sleep and mortality risks.

According to the findings published in JAMA Network Open, there was a link between shorter sleep durations and heightened all-cause mortality risks, which emphasizes the need for further exploration into the potential health benefits of extending sleep among those with OSA and short sleep duration. With 2574 participants enrolled between 1995 and 1998, this research aimed to explore whether the duration of sleep could independently influence mortality rates in this population.

Participants in the study were identified as having OSA based on an apnea-hypopnea index (AHI) equal to or greater than 15. The study followed these individuals, with a median follow-up period of 11.8 years. Sleep duration was categorized into 4 groups: (1) at least 7 hours, (2) 6 to less than 7 hours, (3) 5 to less than 6 hours, and (4) less than 5 hours. Objective sleep duration was determined by total sleep time on polysomnography (PSG) at baseline.

Of the 2574 participants (63.2% men; mean age, 65.4 years), 688 all-cause deaths were observed during the study period. The analysis revealed a significant association between sleep duration and all-cause mortality. Compared with participants sleeping at least 7 hours, those with shorter sleep durations had higher risks of all-cause mortality, even after adjusting for the AHI.

Specifically, HR by group was as follows:

• 6 to less than 7 hours: HR 1.53 (95% CI, 1.13-2.07)
• 5 to less than 6 hours: HR 1.40 (95% CI, 1.03-1.90)
• Less than 5 hours: HR 1.64 (95% CI, 1.20-2.24)

Sensitivity analyses, accounting for positive airway pressure treatment during follow-up, largely supported these findings, though the HR for the group with 5 to less than 6 hours was not statistically significant, the researchers noted.

The study's limitations included the potential impact of the first-night effect on sleep duration, reliance on self-reported sleep habits, and exclusion of participants with sleep durations over 9 hours. Additionally, incomplete follow-up data and potential bias in repeated polysomnography at 5 years and the exclusion of continuous positive airway pressure (CPAP) treatment at baseline introduce uncertainties. While sensitivity analysis was performed, addressing some concerns, the study acknowledged further research is needed to better understand the relationship between sleep duration and mortality risks in individuals with OSA.

The results of this cohort study suggest individuals with OSA who experience shorter sleep durations face a higher risk of all-cause mortality, independent of the severity of apnea as measured by AHI, the researchers wrote. The findings underscore the potential health implications of sleep duration in patients with OSA and advocate for further investigation to explore the benefits of extending sleep duration in this population.

Reference

Lin Y, Wu Y, Lin Q, et al. Objective sleep duration and all-cause mortality among people with obstructive sleep apnea. JAMA Netw Open. 2023;6(12):e2346085. doi:10.1001/jamanetworkopen.2023.46085