Risk of Obstructive Sleep Apnea in Patients with Emphysema Versus Bronchiectasis: A Propensity Score-Matched Cohort Study

Background: Obstructive sleep apnea (OSA) is common in patients with chronic respiratory disease, but whether its risk differs between emphysema and bronchiectasis remains unclear. We compared the subsequent risk of OSA between these two structural lung diseases using a large real-world database. Methods: This retrospective cohort study used data from the TriNetX research network. Adults with emphysema or bronchiectasis were identified and followed for incident OSA. Baseline demographic characteristics, comorbidities, and medication use were balanced using 1:1 propensity score matching. OSA risk was evaluated at 1-, 2-, 3-, 4-, and 5-year intervals and cumulatively through 29 July 2026, using risk ratios, odds ratios, and hazard ratios (HRs). Results: Before matching, 526,877 patients with emphysema and 147,700 with bronchiectasis were included. After propensity score matching, 129,761 patients remained in each cohort, with all standardized differences below 0.10. In the matched analysis, OSA risk was modestly lower in the emphysema group at 1 year (HR = 0.829, 95% CI = 0.778–0.883), 2 years (0.885, 0.843–0.931), 3 years (0.923, 0.884–0.964), 4 years (0.946, 0.910–0.984), and 5 years (0.960, 0.925–0.995). However, the cumulative hazard did not differ significantly between groups (HR = 1.006, 95% CI = 0.976–1.038). Conclusion: After propensity score matching, bronchiectasis was associated with a modestly higher early risk of OSA, but this difference diminished over time and was absent over long-term follow-up. These findings should be considered hypothesis-generating and warrant prospective confirmation.