• Pamela L Lutsey, Islam Zineldin, Jeffrey R Misialek, Kelsie M Full, Kamakshi Lakshminarayan, Junichi Ishigami, Logan T Cowan, Kunihiro Matsushita, and Ryan T Demmer.
• Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN. Electronic address: lutsey@umn.edu.
• Chest. 2023 Apr 1; 163 (4): 942952942-952.

BackgroundOSA has been linked to microaspiration, systemic inflammation, and suboptimal immune function.Research QuestionIs OSA prospectively associated with risk of hospitalization for pneumonia, respiratory, and total infections?Study Design And MethodsProspective cohort. Participants in the Atherosclerosis Risk in Communities (ARIC) study (N = 1,586) underwent polysomnography in 1996-1998 and were followed up through 2018 for infection-related hospitalizations. The apnea-hypopnea index (AHI; events/h) was used to categorize participants as having severe OSA (≥ 30), moderate OSA (15-29), mild OSA (5-14), or a normal breathing pattern (< 5). Cox regression was used to calculate hazard ratios (HRs) and 95% CIs.ResultsARIC participants were on average 62.7 (SD = 5.5) years of age, and 52.8% were female. Severe OSA was present in 6.0%, moderate OSA in 12.7%, mild OSA in 30.0%, and normal breathing in 51.3%. A total of 253 hospitalizations with pneumonia occurred over a median 20.4 (max, 22.9) years' follow-up. Participants with severe OSA were at 1.87 times (95% CI, 1.19-2.95) higher risk of hospitalization with pneumonia compared with those with a normal breathing pattern after adjustment for demographics and lifestyle behaviors. Results were attenuated modestly after adjustment for BMI (1.62 [0.99-2.63]), and prevalent asthma and COPD (1.62 [0.99-2.63]). A similar pattern existed for hospitalization with respiratory infection and composite infection (demographic and behavior-adjusted HRs: 1.47 [0.96-2.25] and 1.48 [1.07-2.04], respectively).InterpretationSevere OSA was associated with increased risk of hospitalizations with pneumonia in this community-based cohort. OSA patients may benefit from more aggressive efforts to prevent pneumonia and other infectious conditions.Copyright © 2023. Published by Elsevier Inc.

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