Objective:

To analyze obstructive sleep apnea (OSA) and stroke-related mortality (OSA+stroke) in the United States (US) from 1999 to 2023, stratified by sex, ethnicity, urbanization, state, region, place of death, and stroke subtype.

Background:

Stroke remains a leading cause of mortality worldwide despite declining death rates. OSA is an underrecognized risk factor linked to small vessel disease. Prior studies have examined their mortality individually or in association with other cardiovascular conditions but have offered limited evaluation of their combined burden or long-term trends.

Design/Methods:

Mortality data for individuals aged ≥45 years were obtained from the CDC WONDER Multiple Cause of Death database. OSA (ICD-10 G47.3) and stroke (I60.0 to I60.9, I61.0 to I61.9, I63.0 to I63.9, I64, I69.0, I69.1, I69.3, and I69.4) were identified as underlying or contributing causes of death. Crude rates (CR) and age-adjusted mortality rates (AAMR) per 100,000 population were calculated and standardized to the 2000 U.S. population. Annual percent change (APC) was estimated using Joinpoint regression.

Results:

OSA+stroke mortality increased 7.3-fold, with AAMR rising from 0.16 (95% CI: 0.13–0.19) to 1.17 (95% CI: 1.12–1.23) from 1999 to 2023. Mortality rose until 2018 (APC: 7.81%, p<0.05), accelerated between 2018-2021 (APC: 17.79%, p<0.05), then declined slightly. Mortality was highest among men, NH Blacks, residents of the Western region, and those living in nonmetropolitan areas, whereas the Northeast reported the lowest rates, with most deaths (45.7%) occurring in medical facilities. Ischemic stroke accounted for more OSA-related deaths than hemorrhagic stroke, with both subtypes rising after 2017.

Conclusions:

OSA+stroke mortality has increased substantially since 1999, suggesting that OSA may contribute to residual stroke risk. Persistently elevated mortality rates among men and NH Blacks warrant independent risk factor analysis and better diagnostic modalities. Additionally, rural or high-burden regions mandate better accessibility models and equitable distribution of physicians across the U.S.