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Mortality in sleep apnoea syndrome: a review of the evidence

CORRESPONDENCE: P. Lavie, Lloyd Rigler Sleep Apnoea Research Laboratory, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Rappaport Building, Efron Street, Bat Galim, Haifa, Israel. Fax: 972 48343934. E-mail: plavie{at}tx.technion.ac.il

Sleep apnoea syndrome is associated with cardiovascular morbidity, but it is less clear if it is also associated with increased mortality.

Studies investigating mortality in sleep apnoea have 1) compared mortality rates of patients with different levels of severity of the syndrome relying on sleep laboratory populations, 2) compared treated and untreated patients, 3) examined the effect of co-existing cardiovascular diseases on survival and 4) investigated the effect of sleep-disordered breathing on mortality in the elderly.

In spite of methodological limitations, the accumulated data generally support an increased risk of mortality in patients with severe sleep apnoea in comparison with mild or no sleep apnoea, and indicate that efficient treatment decreases mortality. Surprisingly, several studies have shown that the highest risk of mortality in sleep apnoea occurs in patients younger than 50 yrs of age, that risk tends to decline with age and that the occurrence of disordered breathing in sleep in the elderly does not affect mortality. It is as yet unclear if this finding represents a selection bias, differences in apnoea severity or in compliance with treatment between young and old patients, or an adaptation to the syndrome with age.

There is conflicting evidence as to whether the occurrence of sleep apnoea in patients with existing cardiovascular diseases increases the risk of mortality beyond that associated with the cardiovascular diseases themselves.

KEYWORDS: All-cause mortality, cardiovascular mortality, continuous positive airway pressure, sleep apnoea