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Higher apnoea-hypopnoea index is associated with reduced exercise capacity and increased all-cause mortality in a general population

In a population-based study of 1001 participants, a higher AHI was inversely associated with peak oxygen uptake (V'O2 peak) and significantly associated with all-cause mortality over a median 10.3-year follow-up (hazard ratio 1.31-1.72). Mediation analysis suggested a possible but non-significant indirect effect via reduced exercise capacity.

Last updated: Jul 30, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score34/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Association of obstructive sleep apnoea with exercise capacity and mortality in a population-based study: results of SHIP-TREND.

observational

Obst A, Stubbe B, Kaczmarek S, Daboul A, Krüger M, Völzke H, Penzel T, Fietze I, Ewert R · ERJ open research (2026)

Participants: N/A
Duration: 10.3 years (median follow-up)
Intervention: Observational assessment of sleep characteristics (AHI, oxygen desaturation index) via single-night polysomnography
Outcome: Peak oxygen uptake (V'O2 peak) from cardiopulmonary exercise testing and all-cause mortality
Effect Size: Hazard ratio 1.31-1.72 for AHI with all-cause mortality
Population: General population adults aged 44-63 years from the SHIP-TREND cohort (47.1% women, mean age 54 years)

Result:

PubMed: 42516907DOI: 10.1183/23120541.01520-2025

Mechanism Graph

Obstructive sleep apnoea leads to intermittent hypoxia and sleep fragmentation
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These disturbances impair cardiovascular and respiratory function
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Reduced cardiopulmonary fitness (lower V'O2 peak) may contribute to mortality risk
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Result: Elevated AHI is directly associated with increased mortality, with a non-significant indirect pathway through reduced exercise capacity

Limitations

  • ⚠Observational design cannot establish causality
  • ⚠Mediation analysis showed non-significant indirect effect, limiting conclusions about the mediating role of exercise capacity

Frequently Asked Questions

What is the apnoea-hypopnoea index (AHI) and how was it measured?▼

AHI measures the number of apnoea and hypopnoea events per hour of sleep, assessed via single-night polysomnography in this study.

Did the study find that exercise capacity mediates the link between sleep apnoea and mortality?▼

No, the indirect effect via V'O2 peak was not statistically significant, though a possible role was suggested for further investigation.

How many participants died during follow-up?▼

73 deaths occurred over a median follow-up of 10.3 years.

What was the average AHI in men versus women?▼

Men had a higher AHI (7.9 events/h) compared to women (2.6 events/h).

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References

  1. 1.Obst A, Stubbe B, Kaczmarek S, Daboul A, Krüger M, Völzke H, Penzel T, Fietze I, Ewert R. "Association of obstructive sleep apnoea with exercise capacity and mortality in a population-based study: results of SHIP-TREND.." ERJ open research, 2026. PMID: 42516907 DOI: 10.1183/23120541.01520-2025
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.