{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T02:49:18Z","timestamp":1792205358506,"version":"4.4.0"},"reference-count":22,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ARM"],"abstract":"<jats:p>Obstructive sleep apnea (OSA) is associated with increased risks of systemic comorbidities, leading to significant morbidity and mortality. This study investigates predictors of all-cause mortality, emphasizing the interplay of clinical symptoms, polysomnographic findings, and comorbidities. The aim of this study was to identify and compare respiratory predictors of all-cause mortality over 5, 10, and 15 years. A single-center study was conducted at a Sleep Medicine Department between 2005 and 2019, 4025 patients with suspected OSA who underwent polysomnography were admitted, 853 died during the study. We performed Cox regression analyses with dynamic hazard ratios to evaluated predictors of mortality. Prevalence of OSA was high\u201475.6% in the cohort: 929 patients with mild OSA (23.1%), 770 with moderate OSA (19.1%), and 1343 with severe OSA (33.4%). Survival rates were 89.7%, 81.9%, and 78.8% at 5, 10, and 15 years, respectively. Cardiovascular causes dominated mortality (33.3%), followed by cancer (26.5%). AHIREM was associated with higher mortality risk in 0\u20135, 0\u201310, 0\u201315 years of observation in contrast to AHINREM and AHITST. The hazard ratio analysis showed that mortality risk changed over time depending on sleep stage and event type: risk increased for AHIREM and AHITST, while it stayed the same or decreased for AHINREM and most central apneas.<\/jats:p>","DOI":"10.3390\/arm93050046","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T07:33:50Z","timestamp":1760686430000},"page":"46","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Beyond the Apnea\u2013Hypopnea Index: Exploring Time-Dependent Hazard Ratios of Respiratory Events in Obstructive Sleep Apnea"],"prefix":"10.3390","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4635-2103","authenticated-orcid":false,"given":"Wojciech","family":"Kuczy\u0144ski","sequence":"first","affiliation":[{"name":"Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka 6\/8, 92-215 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Kudrycka","sequence":"additional","affiliation":[{"name":"Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka 6\/8, 92-215 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2228-8744","authenticated-orcid":false,"given":"Karol","family":"Pierzcha\u0142a","sequence":"additional","affiliation":[{"name":"Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka 6\/8, 92-215 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izabela","family":"Grabska-Koby\u0142ecka","sequence":"additional","affiliation":[{"name":"Department of Clinical Physiology, Medical University of Lodz, Mazowiecka 6\/8, 92-215 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Pencina","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University, 300 West Morgan St., Durham, NC 27701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6127-3403","authenticated-orcid":false,"given":"Sebastian","family":"Sakowski","sequence":"additional","affiliation":[{"name":"Faculty of Mathematics and Computer Science, University of Lodz, Stefana Banacha 22, 90-238 Lodz, Poland"},{"name":"Centre for Data Analysis, Modelling and Computational Sciences, University of Lodz, Narutowicza 68, 90-136 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Bia\u0142asiewicz","sequence":"additional","affiliation":[{"name":"Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka 6\/8, 92-215 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Kuczy\u0144ski, W., Kudrycka, A., Ma\u0142olepsza, A., Karwowska, U., Bia\u0142asiewicz, P., and Bia\u0142as, A. (2021). The Epidemiology of Obstructive Sleep Apnea in Poland-Polysomnography and Positive Airway Pressure Therapy. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18042109"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1056\/NEJMcp1816152","article-title":"Obstructive Sleep Apnea in Adults","volume":"380","author":"Veasey","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"43","DOI":"10.2147\/NSS.S75166","article-title":"All-cause mortality from obstructive sleep apnea in male and female patients with and without continuous positive airway pressure treatment: A registry study with 10 years of follow-up","volume":"7","author":"Jennum","year":"2015","journal-title":"Nat. Sci. Sleep"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"889","DOI":"10.5664\/jcsm.8354","article-title":"Mild obstructive sleep apnea increases hypertension risk, challenging traditional severity classification","volume":"16","author":"Bouloukaki","year":"2020","journal-title":"J. Clin. Sleep Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1093\/sleep\/32.2.150","article-title":"The New AASM Criteria for Scoring Hypopneas: Impact on the Apnea Hypopnea Index","volume":"32","author":"Ruehland","year":"2009","journal-title":"Sleep"},{"key":"ref_6","first-page":"e950826","article-title":"Overall Mortality and Comorbidities in Obstructive Sleep Apnea in Poland","volume":"31","author":"Kudrycka","year":"2025","journal-title":"Med. Sci. Monit."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"597","DOI":"10.5664\/jcsm.2172","article-title":"Rules for scoring respiratory events in sleep: Update of the 2007 AASM manual for the scoring of sleep and associated events","volume":"8","author":"Berry","year":"2012","journal-title":"J. Clin. Sleep Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s11325-023-02868-3","article-title":"Apnea-hypopnea index and the polysomnographic risk factors for predicting 5- to 8-year mortality in patients with OSA","volume":"28","author":"Varol","year":"2024","journal-title":"Sleep Breath."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"405","DOI":"10.5664\/jcsm.11424","article-title":"Insights, recommendations, and research priorities for central sleep apnea: Report from an expert panel","volume":"21","author":"Kundel","year":"2025","journal-title":"J. Clin. Sleep Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Punjabi, N.M., Caffo, B.S., Goodwin, J.L., Gottlieb, D.J., Newman, A.B., O\u2019Connor, G.T., Rapoport, D.M., Redline, S., Resnick, H.E., and Robbins, J.A. (2009). Sleep-disordered breathing and mortality: A prospective cohort study. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000132"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Bonsignore, M.R., Pepin, J.L., Cibella, F., Barbera, C.D., Marrone, O., Verbraecken, J., Saaresranta, T., Basoglu, O.K., Trakada, G., and Bouloukaki, I. (2021). Excessive Daytime Sleepiness in Obstructive Sleep Apnea Patients Treated with Continuous Positive Airway Pressure: Data from the European Sleep Apnea Database. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.690008"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1164\/rccm.201406-1136OC","article-title":"Obstructive sleep apnea during REM sleep and hypertension: Results of the Wisconsin sleep cohort","volume":"190","author":"Mokhlesi","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e013983","DOI":"10.1136\/bmjopen-2016-013983","article-title":"Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: A meta-analysis","volume":"7","author":"Xie","year":"2017","journal-title":"BMJ Open"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"zsy265","DOI":"10.1093\/sleep\/zsy265","article-title":"Mild-to-moderate sleep apnea is associated with incident hypertension: Age effect","volume":"42","author":"Vgontzas","year":"2019","journal-title":"Sleep"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e13944","DOI":"10.1111\/jsr.13944","article-title":"Mild-to-moderate obstructive sleep apnea and mortality risk in a general population sample: The modifying effect of age and cardiovascular\/cerebrovascular comorbidity","volume":"33","author":"Vgontzas","year":"2023","journal-title":"J. Sleep Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1513\/AnnalsATS.202407-755OC","article-title":"The Association between All-cause Mortality and Obstructive Sleep Apnea in Adults: A U-Shaped Curve","volume":"22","author":"Azarian","year":"2025","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Kim, J.-W., Won, T.-B., Rhee, C.-S., Park, Y.M., Yoon, I.-Y., and Cho, S.-W. (2020). Polysomnographic phenotyping of obstructive sleep apnea and its implications in mortality in Korea. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-70039-5"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Milicic Ivanovski, D., Milicic Stanic, B., and Kopitovic, I. (2023). Comorbidity Profile and Predictors of Obstructive Sleep Apnea Severity and Mortality in Non-Obese Obstructive Sleep Apnea Patients. Medicina, 59.","DOI":"10.3390\/medicina59050873"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1136\/bmj.332.7549.1080","article-title":"The cost of dichotomising continuous variables","volume":"332","author":"Altman","year":"2006","journal-title":"Br. Med. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"121","DOI":"10.21037\/atm.2018.02.12","article-title":"Big-data Clinical Trial Column Time-varying covariates and coefficients in Cox regression models","volume":"6","author":"Zhang","year":"2018","journal-title":"Ann. Transl. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"230166","DOI":"10.1183\/16000617.0166-2023","article-title":"REM sleep obstructive sleep apnoea","volume":"33","author":"Bonsignore","year":"2024","journal-title":"Eur. Respir. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1164\/rccm.202209-1808OC","article-title":"Sleep Apnea Physiological Burdens and Cardiovascular Morbidity and Mortality","volume":"208","author":"Labarca","year":"2023","journal-title":"Am. J. Respir. Crit. Care Med."}],"container-title":["Advances in Respiratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2543-6031\/93\/5\/46\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T08:28:06Z","timestamp":1760689686000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2543-6031\/93\/5\/46"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,16]]},"references-count":22,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["arm93050046"],"URL":"https:\/\/doi.org\/10.3390\/arm93050046","relation":{},"ISSN":["2543-6031"],"issn-type":[{"value":"2543-6031","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,16]]}}}