Objective To investigate the prognostic value of the age-adjusted Charlson comorbidity index(ACCI)in obstructive sleep apnea(OSA)patients over 60 years old.Methods A total of 1183 elderly OSA patients admitted in sleep centers of six hospitals between January 2015 and October 2017 were consecutively enrolled,and they were divided into low(ACCI＜5,847 cases)and high ACCI group(ACCI≥5,336 cases)based on the ACCI threshold.Demographic character-istics,clinical features,sleep parameters,and medical history were obtained from their medical re-cords.ACCI was calculated.All of them patients were followed up,and all-cause mortality was re-garded as the primary outcome.ROC curves were plotted,the AUC values were calculated,and log-rank test and Cox proportional hazards regression model were used for analysis with 5 as the threshold of ACCI.Results During a median follow-up of 43 months,63 deaths(5.3％)occurred.ROC curve analysis showed the optimal cut-off value of ACCI was 4.5,with an AUC value of 0.70(95％CI:0.63-0.77,P＜0.01).Compared with the low ACCI group,the high ACCI group showed significant increases in age,body mass index,smoking,alcohol consumption,hyperten-sion,average apnea time,creatinine,cystatin C,average platelet volume,and all-cause mortality rate,while the average SpO2 and minimum SpO2 were significantly reduced(P＜0.05,P＜0.01).Multivariate Cox regression analysis revealed that total sleep time(HR=1.258,95％CI:1.053-1.503,P=0.011),mean corpuscular volume(HR=1.047,95％CI:1.007-1.087,P=0.019),and ACCI(HR=1.585,95％CI:1.384-1.815,P=0.001)were independent predictors of all-cause mortality in elderly OSA patients.Kaplan-Meier survival analysis indicated that the 6-year surviv-al rate was 56.0％and 92.2％for the high and low ACCI groups,respectively.Stratified analysis by gender and severity suggested that the cumulative survival rate was obviously higher in the low ACCI group than the high ACCI group(Plog rank＜0.01).After adjusting for confounding varia-bles,the mortality risk of the high ACCI group was 3.32 times higher than that of the low ACCI group(95％CI:1.91-5.77,P＜0.01).Conclusion ACCI is a risk predictor for all-cause mortali-ty in elderly OSA patients,and it can provide reference for clinical decision making in elderly OSA patients.

Objective To investigate the prognostic value of the age-adjusted Charlson comorbidity index(ACCI)in obstructive sleep apnea(OSA)patients over 60 years old.Methods A total of 1183 elderly OSA patients admitted in sleep centers of six hospitals between January 2015 and October 2017 were consecutively enrolled,and they were divided into low(ACCI＜5,847 cases)and high ACCI group(ACCI≥5,336 cases)based on the ACCI threshold.Demographic character-istics,clinical features,sleep parameters,and medical history were obtained from their medical re-cords.ACCI was calculated.All of them patients were followed up,and all-cause mortality was re-garded as the primary outcome.ROC curves were plotted,the AUC values were calculated,and log-rank test and Cox proportional hazards regression model were used for analysis with 5 as the threshold of ACCI.Results During a median follow-up of 43 months,63 deaths(5.3％)occurred.ROC curve analysis showed the optimal cut-off value of ACCI was 4.5,with an AUC value of 0.70(95％CI:0.63-0.77,P＜0.01).Compared with the low ACCI group,the high ACCI group showed significant increases in age,body mass index,smoking,alcohol consumption,hyperten-sion,average apnea time,creatinine,cystatin C,average platelet volume,and all-cause mortality rate,while the average SpO2 and minimum SpO2 were significantly reduced(P＜0.05,P＜0.01).Multivariate Cox regression analysis revealed that total sleep time(HR=1.258,95％CI:1.053-1.503,P=0.011),mean corpuscular volume(HR=1.047,95％CI:1.007-1.087,P=0.019),and ACCI(HR=1.585,95％CI:1.384-1.815,P=0.001)were independent predictors of all-cause mortality in elderly OSA patients.Kaplan-Meier survival analysis indicated that the 6-year surviv-al rate was 56.0％and 92.2％for the high and low ACCI groups,respectively.Stratified analysis by gender and severity suggested that the cumulative survival rate was obviously higher in the low ACCI group than the high ACCI group(Plog rank＜0.01).After adjusting for confounding varia-bles,the mortality risk of the high ACCI group was 3.32 times higher than that of the low ACCI group(95％CI:1.91-5.77,P＜0.01).Conclusion ACCI is a risk predictor for all-cause mortali-ty in elderly OSA patients,and it can provide reference for clinical decision making in elderly OSA patients.