Expert Commentary

Sleep-disordered breathing and all-cause mortality in the sleep heart health study.

David N. Neubauer, MD

Associate Professor, Department of Psychiatry
Johns Hopkins University School of Medicine
Associate Director, Johns Hopkins Sleep Disorders Center
Baltimore, Maryland

Sleep-disordered breathing (SDB) is associated with multiple cardiovascular comorbidities and has recently been found to be associated with an increase in all-cause mortality, specifically with death due to coronary artery disease. This finding from the large (N = 6,441), prospective Sleep Heart Health Study (SHHS)[1] included a sex- and age-stratified analysis demonstrating a hazard ratio for all-cause mortality of 2.09 comparing men 40- to 70-years-old who had severe SDB with those who did not. SDB is represented primarily by OSA and is present in ~24% of men and 9% of women in the US[2]. However, in the older (ie, ≥40 years) SHHS participant group, more than half of the men and a third of the women had some degree of symptoms. Dr. Neubauer points out in a published commentary on the Punjabi et al study[3], that clinicians need to identify patients with sleep disorders in order to evaluate the significant comorbid risks and also suggests that, although the disorder occurs predominantly and with greater severity in men, its effects on women merit further study.


  1. Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009;6:e1000132.
  2. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: A population health perspective. Am J Respir Crit Care Med. 2002;165:1217–1239.
  3. Neubauer DN. Sleep-disordered breathing and all-cause mortality in the Sleep Heart Health Study. Postgrad Med. 2009; 121:6.


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