0490 Sleep Apnea Severity Has a U-shaped Association with All-cause Mortality

Abstract Introduction Sleep apnea (SA) severity is determined by apnea hypopnea index (AHI). The interaction between SA and mortality is debated. We explored the relationship between severity of SA and mortality. We further investigated the effect of age on this relationship. Methods We developed an Natural Language Processing program (evaluated with 972 notes manually annotated notes) to extract apnea hypopnea index (AHI) from text of physician interpretation of sleep studies, i.e., polysomnograms and home sleep apnea testing, performed at the veteran health administration (VA) from 2000-2022. We grouped the participants to no-SA (n-SA, AHI 5), mild to moderate SA (m-SA, 5 AHI 30) and severe SA (s-SA, AHI30). We further stratified the cohort based on age: Young, 40; Middle, 40 and 65; and older, 65 adults. Using logistic regression, we estimated odds ratio (aOR) for mortality adjusted for age, sex, race, ethnicity, and Charlson-Comorbidity Index using m-SA as reference. Results 427,587 patients (age, 55.1±14.6 years; BMI, 32.7±6.2; male, 90.5% and 65% male) had at least one documented AHI. The NLP algorithm achieved to high recall (89%), specificity (91%) and F1-score (88%). Mortality rates were 10.8%, 7.7%, and 13.4% in the n-SA, m-SA, and s-SA, respectively. aOR for all-cause mortality rates in Young for n-SA was 1.08 (0.94-1.20) vs s-SA 1.20 (1.08-1.26); in Middle Age for n-SA was 1.40 (1.33-1.41) vs s-SA 1.20 (1.15-1.24); and in Older was for n-SA 1.49 (1.45-1.52), s-SA 1.04 (1.00-1.08). Conclusion All-cause mortality rate relates to the severity of SA in a U-Shaped appearance. The U-shape appearance increases markedly with age. Further investigations into mechanisms of the U-Shaped appearance is needed. Support (if any) Supported by NIH-NHLBI-K25 funding (#1K25HL152006-01 J.R.); seed funding by AHBPCE (#FY2024-002 J.R.); and Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX.