To investigate mortality trends and demographic patterns due to Sleep Apnea (SA) and Respiratory Failure (RF) among U.S. adults aged ≥ 25 from 1999 to 2023.

SA is a prevalent condition, that may progress to RF, increasing mortality burden. However, trends in SA and RF related mortality among U.S. individuals remain underexplored.

Mortality data for adults aged ≥25 with SA (G47.3) and RF (J96.0, J96.1, J96.9) were extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Joint-point regression was used to evaluate annual percent change (APCs) with 95 % confidence intervals (CIs).

From 1999 to 2023, there were 71,202 recorded deaths among adults with SA-RF. Overall, the AAMR increased from 0.25 in 1999 to 2.26 in 2023 [AAPC: 9.36* (95% CI, 8.89-10.03)]. The rate surged from 1999 to 2008 (APC: 14.04*) and continued rising through 2018 (APC:6.41*). It increased sharply until 2021 (APC: 22.21*), and then declined to 2023 (APC: -12.01*). From 1999 to 2006, the mortality rates for SA and RF combined increased, while rates for RF alone declined [APC: -0.14]. Males (1.43) had higher AAMRs than females (0.96). Non-Hispanic (NH) African-Americans showed the highest AAMRs (1.36), followed by Whites (1.25) and Hispanics (0.70). Regionally, Midwest exhibited the highest AAMR (1.37), followed by West (1.29), South (1.10) and Northeast (0.93). States, Nebraska (1.92) and New York (0.58) had the highest and lowest AAMRs, respectively, while non-metropolitan areas (1.18) exceeded metropolitan areas (0.94). Adults aged 75–84 had the highest crude mortality rate (4.84).

After decades of rising trends, SA-RF mortality has slightly declined, but the long-term increase from 1999 to 2021 signals a risk of rebound. High-risk groups include males, older adults, NH Blacks, Midwest, Nebraska and rural residents. These findings underscore the need for targeted interventions to reduce mortality in these subgroups.