Sleep & breathing = Schlaf & Atmung · 2026
Impact of obstructive lung disease and sleep apnea symptoms on cardiovascular risk and all-cause mortality: insights from a community-dwelling cohort.
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Jonassen Trygve M, Bjorvatn Bjørn, Saeed Sahrai, M Eagan Tomas, Lehmann Sverre
Аннотация
PURPOSE: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are prevalent conditions with overlapping pathophysiological mechanisms. Their coexistence, termed overlap syndrome, is thought to amplify cardiometabolic risk. This study examined the 10-year risk of major adverse cardiovascular events (MACE) and all-cause mortality in individuals with COPD and OSA symptoms in a community-based cohort.
METHODS: Baseline data (1998-1999) from the Hordaland Health Study were linked to national registries on mortality and cardiovascular events. Of 7,456 eligible adults born 1925-1927 and 1950-1951, a random sample of 5,100 was invited, and 3,305 with valid spirometry were included. OSA symptoms were assessed by questionnaire, and chronic airway obstruction (CAO) was defined as post-bronchodilator FEV₁/FVC < 0.70. Cox regression estimated hazard ratios (HR) for MACE and all-cause mortality.
RESULTS: CAO independently predicted both MACE (HR 1.48, 95% CI 1.12-1.97, p < 0.006) and all-cause mortality (HR 1.78, 95% CI 1.44-2.22, p < 0.001). Excessive daytime sleepiness (EDS) was associated with increased mortality (HR 1.37, 95% CI 1.01-1.85, p = 0.045). A significant interaction was found between CAO and habitual snoring, with participants displaying both having more than a twofold increased risk of mortality (HR 2.22, 95% CI 1.31-3.76, p = 0.003).
CONCLUSIONS: CAO and EDS emerged as independent predictors of mortality, while the coexistence of CAO and snoring conferred synergistic risk. These findings highlight the need to recognize OSA symptoms in patients with obstructive lung disease, as they may identify a vulnerable subgroup at heightened risk. Future studies using objective sleep assessments are warranted to clarify mechanisms and guide preventive strategies.
METHODS: Baseline data (1998-1999) from the Hordaland Health Study were linked to national registries on mortality and cardiovascular events. Of 7,456 eligible adults born 1925-1927 and 1950-1951, a random sample of 5,100 was invited, and 3,305 with valid spirometry were included. OSA symptoms were assessed by questionnaire, and chronic airway obstruction (CAO) was defined as post-bronchodilator FEV₁/FVC < 0.70. Cox regression estimated hazard ratios (HR) for MACE and all-cause mortality.
RESULTS: CAO independently predicted both MACE (HR 1.48, 95% CI 1.12-1.97, p < 0.006) and all-cause mortality (HR 1.78, 95% CI 1.44-2.22, p < 0.001). Excessive daytime sleepiness (EDS) was associated with increased mortality (HR 1.37, 95% CI 1.01-1.85, p = 0.045). A significant interaction was found between CAO and habitual snoring, with participants displaying both having more than a twofold increased risk of mortality (HR 2.22, 95% CI 1.31-3.76, p = 0.003).
CONCLUSIONS: CAO and EDS emerged as independent predictors of mortality, while the coexistence of CAO and snoring conferred synergistic risk. These findings highlight the need to recognize OSA symptoms in patients with obstructive lung disease, as they may identify a vulnerable subgroup at heightened risk. Future studies using objective sleep assessments are warranted to clarify mechanisms and guide preventive strategies.