Chest
Volume 94, Issue 1, July 1988, Pages 9-14
Journal home page for Chest

Clinical Investigations
Mortality and Apnea Index in Obstructive Sleep Apnea: Experience in 385 Male Patients

https://doi.org/10.1378/chest.94.1.9Get rights and content

Although obstructive sleep apnea (OSA) has been studied in detail for over a decade, the mortality of this disorder is unclear. We calculated cumulative survival in 385 male OSA patients. We found that those with an apnea index (AI) >20 had a much greater mortality than those with AI = <20. The probability of cumulative eight-year survival was .96± 0.02 (SE) for AI = <20 vs .63±0.17 for AI>20 (p<.05). This difference in mortality related to AI was particularly true in the patients less than 50 years of age in whom mortality from other causes is not common. None of the patients treated with tracheostomy or nasal CPAP died. Eight of the patients treated with uvulopalatopharyngoplasty (UPPP) died and the cumulative survival of the UPPP-alone treated group was not different from the survival curve of untreated OSA patients with an apnea index of greater than 20. We conclude that OSA patients with an apnea index of greater than 20 have a greater mortality than those below 20 and that UPPP patients be restudied after therapy. If the latter patients are found not to have marked amelioration of their AI, then they should be treated by nasal CPAP or tracheostomy.

Section snippets

Methods

Data were gathered from the charts of all patients who underwent evaluation of sleep apnea between 1978 and 1986 and had at least five abnormal respiratory events per hour of sleep (see definitions below). For evaluation of apnea, all patients had a complete sleep and medical history, physical examination, completed a sleep questionnaire, and received an all-night polysomnogram. All recordings included standard placements for continuous monitoring of the central and occipital

Results

Data concerning mortality were available for 385 males above the age of 15. The characteristics of the patient subgroups are shown in Table 2. There were 246 adult male patients who were not treated with tracheostomy, CPAP, or UPPP The cumulative survival of this group is shown in Figure 1.

Discussion

Of 385 male OSA patients, 22 died between 1978 and 1986. Patients with an AI exceeding 20 have a higher mortality than patients with an AI of less than 20. This effect is apparent when examining the population of individuals below the age of 50 years when other diseases normally do not increase mortality. On the other hand, on examining the population above the age of 50, the result is not as clear cut. This is probably related to the fact that other diseases start to have an effect on

Conclusions

Patients with AI indices >20 have an increased mortality, and two of the commonly used treatments have an effect on prolonging survival. Our data for UPPP suggest that: 1) a clinical trial of this therapy be evaluated, and 2) that these patients should be restudied post-surgery and followed-up closely by their physicians on a long-term basis.

ACKNOWLEDGMENTS

We wish to thank Steven Poplaw for his help in data reduction.

References (15)

There are more references available in the full text version of this article.

Cited by (0)

Manuscript received April 15; accepted April 21 for rapid publication processing.

View full text