Impact of obstructive sleep apnea and CPAP treatment on mortality and cardio and cerebrovascular consequences in men of the general population after 20 years of follow-up

Introduction: Obstructive sleep apnea (OSA) seems to be associated with an increased rate of cardiovascular events and greater mortality. The objective of this study was to assess the effect of OSA and its treatment with continuous positive airway pressure (CPAP) on cardio and cerebrovascular morbimortality. Methods: Prospective study between 1993 and 1995 in which 1050 men aged 30 to 70 years old of the general population from Vitoria-Gasteiz were included. Clinical data were collected and a respiratory poligraphy was performed at the beginning and end of the study. Kaplan-Meier and Cox regression models were used. Results: Of the 1050 subjects [median age 48.0 (17.0), BMI 25.9 (4.0), AHI 6.0 (10.0)] follow-up data were obtained in 1014 men after a median of 269,0 (10,0) months [median age 69.0 (16.4), BMI 27.5 (3.9), AHI 19.0 (18.0)]. 59,2% of them had an AHI ≥ 5/h at baseline, and up to 95,8% of them at the end of the study. At the end there had been 196 (19.3%) deaths, 57 (6.0%) episodes of cerebrovascular disease and 220 (23.0%) of cardiovascular disease. Analysis showed no significant association between cardio-cerebrovascular events and OSA detected in the baseline study (p=0,212). Mortality was significantly increased in the OSA at baseline group compared with non OSA/CPAP treated patients, both in mild [HR 1,61 (1,14-2,27), p=0,007)] and in moderate-severe [HR 1,82 (1,23-2,68), p=0,003] OSA groups. Main mortality cause was cancer (50%). Conclusion: OSA prevalence significantly increases after 20 years of follow up. Non-treated OSA is associated with greater mortality.