National trends in mortality associated with obstructive sleep apnea among adults with diabetes mellitus in the United States, 1999–2020

Background: Obstructive sleep apnea (OSA) and diabetes mellitus are two prevalent and interrelated chronic conditions that contribute significantly to cardiovascular and metabolic mortality. However, national trends in OSA-related mortality among adults with diabetes remain poorly characterized. Methods: We conducted a cross-sectional analysis of U.S. death certificate data from 1999 to 2020 using the CDC WONDER platform. Adults aged ≥25 years with diabetes mellitus (ICD-10: E10-E14) as the underlying cause of death and OSA (G47.33) as a contributing cause were included. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population, and temporal trends were assessed using Joinpoint regression. Results: A total of 79,728 deaths were attributed to diabetes and OSA. The overall AAMR was 1.55 (95 % CI: 1.50 to 1.60), increasing significantly from 1999 to 2004 (APC: 19.42 %) and more gradually from 2005 to 2020 (APC: 6.86 %). Males had nearly double the mortality rate of females (2.13 vs. 1.07). The highest AAMRs were observed among American Indian or Alaska Native (2.16) and Black (1.98) individuals. Non-metropolitan areas had higher mortality than metropolitan areas (1.91 vs. 1.48), and the Midwest had the highest regional AAMR (1.95). Crude mortality increased with age, peaking at 5.42 in the 75-84 age group. State-level AAMRs varied nearly sixfold. Most deaths occurred at home (38.5 %), followed by inpatient facilities (32.8 %). Conclusions: Mortality related to OSA in adults with diabetes has risen substantially across all demographics, underscoring the need for targeted interventions in high-risk groups.