Obstructive sleep apnea, preserved ratio impaired spirometry (PRISm), and all-cause mortality: a community-based prospective study.

Abstract

The association between obstructive sleep apnea (OSA) and preserved ratio impaired spirometry (PRISm) has not been well studied. This prospective cohort study enrolled 3408 adults aged 20-79 years without airflow obstruction. The median follow-up time was 11.8 years. Probable OSA (pOSA) was defined based on symptoms (snore, snort/stop breathing, sleepy) and was divided into a normal lung function group (FEV1 ≥ 80% predicted) and a PRISm group (FEV1 < 80% predicted) according to spirometry. Multivariable regression was used to analyze the association between pOSA and PRISm, and Cox regression and Kaplan-Meier analysis were used to assess the effects of pOSA alone, PRISm alone, and both on the risk of mortality. All analyses used survey weights. At baseline, 28.5% of participants presented with pOSA, and 11.4% had PRISm. Multivariable analysis showed an independent association between pOSA and PRISm (adjusted OR = 1.40, 95% CI 1.01-1.94, p = 0.04). Individuals with comorbid pOSA and PRISm had the highest risk of death (adjusted HR = 2.34, 95% CI 1.55-3.55) compared with individuals with PRISm alone (adjusted HR = 1.78, 95% CI 1.3-2.44), while individuals with pOSA alone were not significantly associated with death (adjusted p = 0.893). Kaplan-Meier analysis confirmed significant survival differences between the groups (p < 0.0001). Our results show that individuals with suspected OSA are associated with a higher prevalence of PRISm and individuals with comorbid OSA and PRISm have a higher risk of all-cause death. Although the limitations of the observational study do not allow us to determine causality, it emphasizes that the association between OSA and PRISm deserves further in-depth study.