Azarian Mehrnaz, Ramezani Amin, Sharafkhaneh Amir, Maghsoudi Arash, Kryger Meir, Thomas Robert J, Westover M Brandon, Razjouyan Javad
Center for Innovations in Quality, Effectiveness, and Safety and.
Department of Medicine, Baylor College of Medicine, Houston, Texas.
Ann Am Thorac Soc. 2025 Apr;22(4):581-590. doi: 10.1513/AnnalsATS.202407-755OC.
The relationship between sleep apnea (SA) and mortality remains a topic of debate. We explored the relationship between the severity of SA and mortality and the effect of age on this association. Using a veterans' database, we extracted an apnea-hypopnea index (AHI) from physician interpretations of sleep studies by developing a natural language processing pipeline (with 944 manually annotated notes), which achieved more than 85% accuracy. We categorized the participants into no SA (n-SA; AHI, <5), mild to moderate SA (m-SA; 5 ⩽ AHI < 30), and severe SA (s-SA; AHI, ⩾30). We propensity-matched the m-SA and s-SA categories with n-SA on the basis of age, sex, race, ethnicity, body mass index, and 38 components of the Elixhauser Comorbidity Index. Using logistic regression, we estimated the odds ratio (OR) for all-cause mortality using m-SA as a reference. Also, we stratified the findings on the basis of age: young, ⩽40; middle aged, >40 and <65; and older, ⩾65 adults. We extracted the AHI on 179,121 propensity-matched participants (mean age = 45.85 [SD = 14.1]; BMI = 30.15 ± 5.37 kg/m; male, 79.09%; White, 64.5%). All-cause mortality rates among three AHI categories showed a U-shaped curve (11.55%, 7.07%, and 8.15% for n-SA, m-SA, and s-SA, respectively), regardless of age group. Compared with m-SA, the odds of all-cause mortality in n-SA (OR, 1.72; 95% confidence interval = 1.65-1.79) and s-SA (OR, 1.17; 95% confidence interval = 1.12-1.22) were higher. Stratifying by age yielded consistent findings. All-cause mortality showed a U-shaped association with the AHI. Further investigations to understand the underlying mechanisms of this phenomenon are warranted.
睡眠呼吸暂停（SA）与死亡率之间的关系仍是一个有争议的话题。我们探讨了SA严重程度与死亡率之间的关系以及年龄对这种关联的影响。利用一个退伍军人数据库，我们通过开发一个自然语言处理管道（对944条人工标注的记录）从医生对睡眠研究的解读中提取了呼吸暂停低通气指数（AHI），该管道的准确率超过85%。我们将参与者分为无SA（n-SA；AHI<5）、轻度至中度SA（m-SA；5≤AHI<30）和重度SA（s-SA；AHI≥30）。我们根据年龄、性别、种族、民族、体重指数和Elixhauser合并症指数的38个组成部分，对m-SA和s-SA类别与n-SA进行倾向匹配。使用逻辑回归，我们以m-SA为参照估计全因死亡率的比值比（OR）。此外，我们根据年龄对结果进行分层：年轻人，≤40岁；中年人，>40岁且<65岁；老年人，≥65岁。我们从179,121名倾向匹配的参与者中提取了AHI（平均年龄=45.85[标准差=14.1]；体重指数=30.15±5.37kg/m²；男性，79.09%；白人，64.5%）。无论年龄组如何，三个AHI类别中的全因死亡率均呈U形曲线（n-SA、m-SA和s-SA分别为11.55%、7.07%和8.15%）。与m-SA相比，n-SA（OR，1.72；95%置信区间=1.65-1.79）和s-SA（OR，1.17；95%置信区间=1.12-1.22）的全因死亡几率更高。按年龄分层得出了一致的结果。全因死亡率与AHI呈U形关联。有必要进行进一步调查以了解这一现象的潜在机制。
