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Oxygen desaturation index and apnea–hypopnea index in relation to incident heart failure : The sleep apnea patients in Skaraborg study

Peker, Yüksel LU ; Hjälm, Henrik Holtstrand ; Glantz, Helena ; Pihtili, Aylin and Thunström, Erik (2026) In Sleep Medicine 144.
Abstract

Background Obstructive sleep apnea (OSA) is associated with cardiovascular morbidity; however, it remains unclear whether the apnea–hypopnea index (AHI) or the severity of nocturnal hypoxemia, in terms of oxygen desaturation index (ODI), is more relevant for the development of heart failure (HF). Methods We included 3590 participants from the Sleep Apnea Patients in Skaraborg Study (mean age 54.6 ± 12.8 years, 66% men, mean body mass index 29.6 ± 5.4 kg/m2) without prevalent HF at baseline and with available AHI and ODI data. Participants were followed for a median of 8.7 years (interquartile range 7.4–10.0). AHI and ODI were categorized as <5, 5–15, 15–30, and ≥30 events/hour. HF–free survival was analyzed using... (More)

Background Obstructive sleep apnea (OSA) is associated with cardiovascular morbidity; however, it remains unclear whether the apnea–hypopnea index (AHI) or the severity of nocturnal hypoxemia, in terms of oxygen desaturation index (ODI), is more relevant for the development of heart failure (HF). Methods We included 3590 participants from the Sleep Apnea Patients in Skaraborg Study (mean age 54.6 ± 12.8 years, 66% men, mean body mass index 29.6 ± 5.4 kg/m2) without prevalent HF at baseline and with available AHI and ODI data. Participants were followed for a median of 8.7 years (interquartile range 7.4–10.0). AHI and ODI were categorized as <5, 5–15, 15–30, and ≥30 events/hour. HF–free survival was analyzed using Kaplan–Meier methods and Cox proportional hazards models adjusted for demographic factors, cardiovascular comorbidities, and treatment with positive airway pressure or intraoral device. Results In total, 175 incident HF events occurred. Kaplan–Meier analyses showed lower HF–free survival with increasing AHI and ODI categories. After multivariable adjustment, ODI ≥30 events/hour was associated with a higher risk of incident HF (hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.02–3.08). In contrast, no significant association was observed between AHI and incident HF (AHI ≥30 vs < 5: HR 1.27, 95% CI 0.92–1.75). OSA treatment was not significantly associated with HF risk (HR 0.91, 95% CI 0.66–1.25). Conclusions In this large sleep clinic cohort with long-term follow-up, ODI ≥30 but not AHI ≥30 events/h was linked to the development of HF. These findings challenge the reliance on the AHI alone and highlight nocturnal hypoxemia as a central pathophysiological pathway connecting OSA to incident HF.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Apnea hypopnea index, Heart failure, Obstructive sleep apnea, Oxygen desaturation index
in
Sleep Medicine
volume
144
article number
108991
publisher
Elsevier
external identifiers
  • scopus:105036737633
ISSN
1389-9457
DOI
10.1016/j.sleep.2026.108991
language
English
LU publication?
yes
id
90947bcf-42a3-4fc0-ac5c-6a54abe16743
date added to LUP
2026-05-19 15:44:52
date last changed
2026-05-19 15:45:55
@article{90947bcf-42a3-4fc0-ac5c-6a54abe16743,
  abstract     = {{<p>Background Obstructive sleep apnea (OSA) is associated with cardiovascular morbidity; however, it remains unclear whether the apnea–hypopnea index (AHI) or the severity of nocturnal hypoxemia, in terms of oxygen desaturation index (ODI), is more relevant for the development of heart failure (HF). Methods We included 3590 participants from the Sleep Apnea Patients in Skaraborg Study (mean age 54.6 ± 12.8 years, 66% men, mean body mass index 29.6 ± 5.4 kg/m<sup>2</sup>) without prevalent HF at baseline and with available AHI and ODI data. Participants were followed for a median of 8.7 years (interquartile range 7.4–10.0). AHI and ODI were categorized as &lt;5, 5–15, 15–30, and ≥30 events/hour. HF–free survival was analyzed using Kaplan–Meier methods and Cox proportional hazards models adjusted for demographic factors, cardiovascular comorbidities, and treatment with positive airway pressure or intraoral device. Results In total, 175 incident HF events occurred. Kaplan–Meier analyses showed lower HF–free survival with increasing AHI and ODI categories. After multivariable adjustment, ODI ≥30 events/hour was associated with a higher risk of incident HF (hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.02–3.08). In contrast, no significant association was observed between AHI and incident HF (AHI ≥30 vs &lt; 5: HR 1.27, 95% CI 0.92–1.75). OSA treatment was not significantly associated with HF risk (HR 0.91, 95% CI 0.66–1.25). Conclusions In this large sleep clinic cohort with long-term follow-up, ODI ≥30 but not AHI ≥30 events/h was linked to the development of HF. These findings challenge the reliance on the AHI alone and highlight nocturnal hypoxemia as a central pathophysiological pathway connecting OSA to incident HF.</p>}},
  author       = {{Peker, Yüksel and Hjälm, Henrik Holtstrand and Glantz, Helena and Pihtili, Aylin and Thunström, Erik}},
  issn         = {{1389-9457}},
  keywords     = {{Apnea hypopnea index; Heart failure; Obstructive sleep apnea; Oxygen desaturation index}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Sleep Medicine}},
  title        = {{Oxygen desaturation index and apnea–hypopnea index in relation to incident heart failure : The sleep apnea patients in Skaraborg study}},
  url          = {{http://dx.doi.org/10.1016/j.sleep.2026.108991}},
  doi          = {{10.1016/j.sleep.2026.108991}},
  volume       = {{144}},
  year         = {{2026}},
}