Rising cardiovascular mortality among obstructive sleep apnea patients: United States epidemiological trends (1999-2019)

Background: Obstructive sleep apnea (OSA) prevalence has risen significantly, affecting millions globally and posing a major healthcare burden. OSA is strongly associated with cardiovascular diseases (CVD) such as heart failure, stroke, and ischemic heart disease. However, trends in CVD-related mortality among individuals with OSA remain underexplored. Objective: This study aims to assess the trends of OSA and CVD related mortality rates and variations in mortality based on demographics and regions in the US. Methods: Mortality data for adults aged >= 25 with OSA and CVD were extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent change (APC) with 95 % confidence intervals (CIs) were calculated, stratified by year, sex, race/ethnicity, age, urbanization, and Census regions. Results: Between 1999 and 2019, 168,111 OSA-related CVD deaths were recorded. Overall AAMRs rose significantly, particularly for hypertensive disease (1999-2006 APC: 13.2 %, 95 % CI: 11.6-15.7). Men consistently had higher AAMRs than women, and Black individuals showed the highest racial disparities. AAMRs varied geographically, with the Midwest recording the highest rates and rural areas showing notable increases. States like Oregon and Montana had rates three times higher than New York and Massachusetts. Conclusions: OSA-related CVD mortality has risen substantially, with marked disparities by sex, race, and region. These findings emphasize the need for targeted public health interventions to reduce mortality in high-risk groups.