There has been much speculation on the risk of mortality associated with sleep apnea. We followed-up 233 elderly patients in nursing homes, 70 percent of whom had five or more respiratory disturbances per hour of sleep, to determine if sleep apnea is a predictor of mortality. Cox proportional hazards survival analyses indicated a gender effect, with women having a much better survival rate than men. In women, but not in men, there was a strong association between mortality and the RDI. In addition, patients with obstructive sleep apnea had a greater tendency to die in their sleep. These results show that respiratory disturbances in sleep are an extremely significant risk factor for mortality in elderly women who are in poor health.