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Coexistence of clinically significant obstructive sleep apnea with physician-diagnosed asthma or chronic obstructive pulmonary disease: a population study of prevalence and mortality


Rationale — Despite potential importance, the epidemiology of coexisting obstructive sleep apnea and asthma (OSA/asthma) or OSA and COPD (OSA/COPD) has not been well studied.

Objectives — To access the trends in prevalence and mortality of coexisting OSA/asthma or OSA/COPD among individuals 35-years or older in Ontario, Canada.

Methods and Measurements — We conducted a population-based study using provincial health administrative data. Validated case definitions were used to identify individuals with physician-diagnosed asthma or COPD. Individuals with clinically significant OSA were those who initiated positive airway pressure treatment. Age- and sex-standardized annual prevalence and mortality rates were estimated and compared from 2009 to 2015. Generalized linear models were used.

Main Results — The standardized prevalence increased from 0.42% to 0.66% for OSA/asthma and from 0.23% to 0.35% for OSA/COPD from 2009 to 2015. The standardized all-cause mortality rates remained stable over time. Both coexistence conditions were associated with higher mortality than OSA alone. Adjusting for age, sex and calendar year, mortality was modestly but statistically significantly higher for OSA/asthma than asthma alone (OR = 1.03; 1.00–1.06) with the highest OR noted in 35-49 years old group (1.85; 1.63–2.09). There was no statistical difference in all-cause mortality among individuals with coexisting OSA/COPD compared to patients with COPD alone. In women only, OSA/COPD was associated with a modestly higher mortality than COPD alone (OR = 1.05; 1.01–1.09).

Conclusions — In this population-based study of coexisting clinically significant OSA and chronic lung disease, we report population prevalence and mortality, including their age and sex distribution. These findings can alert healthcare providers and policymakers to the large and increasing burden of these coexisting conditions and high-risk groups.



Kendzerska T, Povitz M, Bai X, Pakhale S, Wen SW, Gershon AS; Canadian Respiratory Research Network. Can J Respir Crit Care Sleep Med. 2022; 6(1):24-34. Epub 2020 Oct 28.

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