Abstract
Background: OSA has been linked to microaspiration, systemic inflammation, and suboptimal immune function. Research Question: Is OSA prospectively associated with risk of hospitalization for pneumonia, respiratory, and total infections? Study Design and Methods: Prospective cohort. Participants in the Atherosclerosis Risk in Communities (ARIC) study (N = 1,586) underwent polysomnography in 1996-1998 and were followed up through 2018 for infection-related hospitalizations. The apnea-hypopnea index (AHI; events/h) was used to categorize participants as having severe OSA (≥ 30), moderate OSA (15-29), mild OSA (5-14), or a normal breathing pattern (< 5). Cox regression was used to calculate hazard ratios (HRs) and 95% CIs. Results: ARIC participants were on average 62.7 (SD = 5.5) years of age, and 52.8% were female. Severe OSA was present in 6.0%, moderate OSA in 12.7%, mild OSA in 30.0%, and normal breathing in 51.3%. A total of 253 hospitalizations with pneumonia occurred over a median 20.4 (max, 22.9) years’ follow-up. Participants with severe OSA were at 1.87 times (95% CI, 1.19-2.95) higher risk of hospitalization with pneumonia compared with those with a normal breathing pattern after adjustment for demographics and lifestyle behaviors. Results were attenuated modestly after adjustment for BMI (1.62 [0.99-2.63]), and prevalent asthma and COPD (1.62 [0.99-2.63]). A similar pattern existed for hospitalization with respiratory infection and composite infection (demographic and behavior-adjusted HRs: 1.47 [0.96-2.25] and 1.48 [1.07-2.04], respectively). Interpretation: Severe OSA was associated with increased risk of hospitalizations with pneumonia in this community-based cohort. OSA patients may benefit from more aggressive efforts to prevent pneumonia and other infectious conditions.
Original language | English (US) |
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Pages (from-to) | 942-952 |
Number of pages | 11 |
Journal | CHEST |
Volume | 163 |
Issue number | 4 |
DOIs | |
State | Published - Apr 2023 |
Bibliographical note
Funding Information:The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health , Department of Health and Human Services , under Contract nos. ( 75N92022D00001 , 75N92022D00002 , 75N92022D00003 , 75N92022D00004 , 75N92022D00005 ). The ARIC portion of the Sleep Heart Health Study (SHHS) was supported by National Heart, Lung, and Blood Institute (NHLBI) cooperative agreements U01 HL53934 ( University of Minnesota ) and U01 HL64360 ( Johns Hopkins University ). P. L. L. was also supported NHLBI K24 HL159246 , K. M. F. by NHLBI T32 HL007779 and J. I. by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) K01 DK125616.
Publisher Copyright:
© 2023
Keywords
- Atherosclerosis Risk in Communities (ARIC) study
- OSA
- Sleep Heart Health Study (SHHS)
- infection
- pneumonia
PubMed: MeSH publication types
- Journal Article
- Research Support, N.I.H., Extramural