0489 Age Modifies the Association Between Severe Sleep Apnea and Mortality

Abstract Introduction Prevalence of sleep apnea (SA) increases with age. However, data on severity of SA and aging and its impact on health outcomes is not known. We assessed the interaction between severity of SA and all-cause mortality in different age categories using large, longitudinal data. Methods We used Natural Language Processing program 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) and severe SA (s-SA, AHI>30) and excluded AHI range of 5-29. We further stratified the cohort based on age: Young, < 40; Middle, >40 and < 65; and older, >65. We calculated odds ratio (aOR) for mortality adjusted for age, sex, race, ethnicity, and Charlson-Comorbidity Index using n-SA as reference. Results We identified 209,374 participants (age, 54.7 ±14.4; BMI 32±5.25; male 90%, White 67%). Prevalence of s-SA increased with age categories as well as CCI. However, increases in BMI between n-SA and s-SA differed with the age categories (30.0 vs 34.1; 30.8 vs. 34.3; and 29.8 vs 32.2, for young, middle-age and elderly, respectively). All-cause mortality rates were higher in s-SA, compared to n-SA independent of age (young, 1.7% vs 1.2%; middle age, 10.41% vs 10.62%; and older adults, 23.04% vs 30.10%). However, the aOR of mortality among s-SA compared to no-SA reversed as the age categories increased (young, 1.14,95%CI:1.04,1.23; middle age, 0.90,95%CI:0.88,0.92; and older adults, 0.83,95%CI:0.59,0.84). Conclusion Although the prevalence of severe SA increases by age, the odds of all-cause mortality compared to no-SA diminished. The data suggests that older adults may be protected against harmful OSA outcomes. A causality analysis is warranted to assess the relationship between sleep apnea, aging, and mortality. Support (if any) Supported by NIH, NHLB Institute K25 funding (1K25HL152006-01 [J.R.]); Airborne Hazards and Burn Pits Center of Excellence (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.