Respiratory effort during sleep predicts mortality in patients with suspected obstructive sleep apnea
Abstract
Rationale: Obstructive sleep apnea (OSA) confers increased risk of morbidity and mortality through mechanisms like exaggerated negative intrathoracic pressure and hypoxemia.
Objectives: Evaluate the association between negative esophageal pressure (PES; a surrogate of respiratory effort) during sleep and long-term all-cause mortality in suspected OSA patients.
Methods: Patients referred with suspected OSA (2003-2016) underwent overnight respiratory polygraphy with PES monitoring. PES, mean oxygen saturation (mSpO2), apnea-hypopnea index (AHI), total time in bed (TiB), and time in bed spent above different PES thresholds (10-60 cmH2O) were recorded. Clinical data and mortality until June 2024 were obtained from medical records. Mortality was analyzed using multivariable Cox regression.
Results: In 16 083 patients (26% female; median age 48 years), median PES was 12.8 cmH2O (IQR 8.7-18.4). Median mSpO2 was 94% (93%-95%), and median AHI was 10 (4.3-21.1); 16% had AHI ≥ 30. During median follow-up of 15 years (IQR 12-18), 1497 (9.3%) died. Patients in the third and fourth quartiles of median PES had increased mortality risk compared to the first quartile. After adjustment for age, sex, body mass index (BMI), comorbidities, AHI, and mSpO2, median PES remained associated with mortality, with the third quartile showing increased risk (hazard ratio [HR] 1.21; 95% CI, 1.03-1.43; P = .024). Longer time spent above higher PES thresholds was associated with increased mortality. Risk rose across quartiles of percentage of TiB at each threshold and increased further with more negative thresholds in the highest quartile.
Conclusion: Respiratory effort, measured by PES during sleep, independently predicts all-cause mortality, and provides prognostic information beyond traditional OSA metrics including AHI and hypoxemia. This supports respiratory effort as a useful component of comprehensive clinical evaluation.
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BibTeX
@article{nahoui2026respiratory,
title = {{Respiratory effort during sleep predicts mortality in patients with suspected obstructive sleep apnea}},
author = {Hamza Nahoui and Henrik Schirmer and Gunnar Einvik and Tarjei Øvrebotten and Kristian Berge and Peder L Myhre and Haldor Husby and Harald Hrubos-Strøm},
journal = {American Journal of Respiratory and Critical Care Medicine},
year = {2026},
month = jun,
doi = {10.1093/ajrccm/aamag344},
url = {https://doi.org/10.1093/ajrccm/aamag344},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Respiratory effort during sleep predicts mortality in patients with suspected obstructive sleep apnea
AU - Hamza Nahoui
AU - Henrik Schirmer
AU - Gunnar Einvik
AU - Tarjei Øvrebotten
AU - Kristian Berge
AU - Peder L Myhre
AU - Haldor Husby
AU - Harald Hrubos-Strøm
PY - 2026
DA - 2026/06/29
JO - American Journal of Respiratory and Critical Care Medicine
DO - 10.1093/ajrccm/aamag344
UR - https://doi.org/10.1093/ajrccm/aamag344
AB - Rationale: Obstructive sleep apnea (OSA) confers increased risk of morbidity and mortality through mechanisms like exaggerated negative intrathoracic pressure and hypoxemia. Objectives: Evaluate the association between negative esophageal pressure (PES; a surrogate of respiratory effort) during sleep and long-term all-cause mortality in suspected OSA patients. Methods: Patients referred with suspected OSA (2003-2016) underwent overnight respiratory polygraphy with PES monitoring. PES, mean oxygen saturation (mSpO2), apnea-hypopnea index (AHI), total time in bed (TiB), and time in bed spent above different PES thresholds (10-60 cmH2O) were recorded. Clinical data and mortality until June 2024 were obtained from medical records. Mortality was analyzed using multivariable Cox regression. Results: In 16 083 patients (26% female; median age 48 years), median PES was 12.8 cmH2O (IQR 8.7-18.4). Median mSpO2 was 94% (93%-95%), and median AHI was 10 (4.3-21.1); 16% had AHI ≥ 30. During median follow-up of 15 years (IQR 12-18), 1497 (9.3%) died. Patients in the third and fourth quartiles of median PES had increased mortality risk compared to the first quartile. After adjustment for age, sex, body mass index (BMI), comorbidities, AHI, and mSpO2, median PES remained associated with mortality, with the third quartile showing increased risk (hazard ratio [HR] 1.21; 95% CI, 1.03-1.43; P = .024). Longer time spent above higher PES thresholds was associated with increased mortality. Risk rose across quartiles of percentage of TiB at each threshold and increased further with more negative thresholds in the highest quartile. Conclusion: Respiratory effort, measured by PES during sleep, independently predicts all-cause mortality, and provides prognostic information beyond traditional OSA metrics including AHI and hypoxemia. This supports respiratory effort as a useful component of comprehensive clinical evaluation.
SN - 1073-449X
SN - 1535-4970
ER -