Rising Mortality from Sleep Apnea and Hypertension in U.S. Adults: A 23-Year Epidemiological Analysis And Impact of the COVID-19 Pandemic (2000–2023)

Obstructive Sleep Apnea (OSA) and hypertension (HTN) are prevalent, interrelated conditions associated with significant cardiovascular morbidity. Despite their rising burden, mortality trends for their co-occurrence remain underexplored. To assess U.S. mortality trends related to OSA and HTN from 2000 to 2023, analyzing demographic, geographic, and temporal patterns. Mortality data for adults aged ≥ 25 were extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent changes (APCs) were calculated using joinpoint regression, stratified by sex, race/ethnicity, age, urbanization, and Census regions. From 2000 to 2023, 127,668 deaths were attributed to OSA and HTN. AAMRs rose from 0.44 (95% CI: 0.41–0.47) in 2000 to 4.87 (95% CI: 4.79–4.96) in 2023, with an average annual percent change of + 11.55% (95% CI: 10.41–12.70). Men had higher mortality rates than women (2023: 7.05 vs. 3.05). Non-Hispanic Black adults exhibited the highest AAMRs, followed by Non-Hispanic Whites and Hispanics. Adults ≥ 65 years accounted for 62.4% of deaths. Rural areas had higher mortality than metropolitan areas (2.04 vs. 1.69). States like Oregon had rates nearly five times higher than New York. Mortality peaked in 2018–2021, aligning with the COVID-19 pandemic. Heart disease was the leading underlying cause. OSA and HTN-related mortality has surged over two decades, with pronounced disparities by sex, race, age, and region. Targeted prevention, screening, and intervention strategies are urgently needed, particularly for elderly, minority, and rural populations.