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Association between hemoglobin and all-cause mortality in patients with obstructive sleep apnea and hypertension: insights from an observational study

Journal of Human Hypertension (2026)Cite this article

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Abstract

Obstructive sleep apnea (OSA) is a widespread disorder impacting more than one billion individuals globally. Hypertension, a frequent cardiovascular comorbidity associated with OSA, can exacerbate and advance the condition. Recent research has identified a synergistic effect between anemia and OSA concerning the development of hypertension. This study explores the relationship between hemoglobin (Hb) and follow-up and 365-day all-cause mortality in individuals suffering from OSA and hypertension. Data were obtained from the MIMIC-IV database. Kaplan-Meier (KM) analyses and Cox proportional hazards models were utilized to assess associations with outcomes. Restricted cubic spline (RCS) models were selected to assess nonlinear relationships. A total of 6155 patients with first-time hospitalization for OSA and hypertension were included in this study. The KM survival curves demonstrated that the survival rate for the lowest Hb quartile (Q1) was significantly lower than that of the other quartiles. Findings from the multivariable Cox regression analysis revealed that elevated Hb correlates with a significant decrease in mortality risk. The RCS analysis demonstrated an L-shaped nonlinear relationship between Hb and outcome events (P-Nonlinear < 0.05). The relationship between Hb and outcome events remained consistent across all subgroups, further supporting the robustness of the conclusions drawn in this study. Hemoglobin is closely associated with all-cause mortality in patients with OSA and hypertension and can serve as an effective biomarker for risk management and prognostic assessment upon admission. Monitoring Hb in patients with OSA and hypertension and actively correcting anemia when present may improve prognostic survival.

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Fig. 1
Fig. 2: K-M survival analysis for mortality in patients with OSA and hypertension.
Fig. 3: Nonlinear relationship between Hb and mortality of OSA and hypertension patients.
Fig. 4: Subgroup analysis for mortality in patients with OSA and hypertension.

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Data availability

After application via the MIMIC database, the dataset generated by this study can be obtained by contacting the corresponding author.

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Acknowledgements

We sincerely appreciate the dedicated efforts of the personnel responsible for the design and maintenance of the MIMIV database.

Funding

This work was supported by grants from the National Natural Science Foundation of China (No. 32400952), Shaanxi Provincial Science and Technology Department (No. 2024JC-YBQN-0791, No.2024SF-LCZX-20, and No. 2020ZDLSF02-09), and IIT Clinical Research Fund of the Second Affiliated Hospital of Xi’an Jiaotong University (No. M023).

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Author notes

  1. These authors contributed equally: Chen Guo, Jia-hao Dou.

Authors and Affiliations

  1. Department of Cardiology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, 710004, China

    Chen Guo, Jia-hao Dou, Fan-shun Guo, Dan-ni Li, Tuo Han & Jin Wei

  2. Clinical Research Center for Endemic Disease of Shaanxi Province, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, 710004, China

    Chen Guo, Jia-hao Dou, Fan-shun Guo, Dan-ni Li, Tuo Han & Jin Wei

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  1. Chen Guo
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Contributions

Study design: CG, JHD. Data extraction: JHD. Analysis: DNL. Visualization: FSG. Supervision: TH. Funding: CG, JW. Manuscript drafting: CG, JHD. Reviewing & editing: JW. Final approval: CG, JHD, FSG, DNL, TH, JW.

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Correspondence to Chen Guo.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

a) All methods were performed in accordance with the relevant guidelines and regulations. b) This study utilized data from MIMIC-IV (Version 3.1), which received institutional review board approval from the Massachusetts Institute of Technology (MIT) (No. 0403000206) and Beth Israel Deaconess Medical Center (BIDMC). Access to the database was granted to author Jia-hao Dou after completing the required Collaborative Institutional Training Initiative (CITI) program and signing the data use agreement. All data usage complied with applicable regulations on privacy, data access, and ethical conduct. c) The IRBs of MIT and BIDMC waived the requirement for informed consent because all patient data in the MIMIC-IV database are fully anonymized before public release to protect patient privacy, and the study was retrospective in nature. d) No identifiable images of human research participants were used in the article.

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Guo, C., Dou, Jh., Guo, Fs. et al. Association between hemoglobin and all-cause mortality in patients with obstructive sleep apnea and hypertension: insights from an observational study. J Hum Hypertens (2026). https://doi.org/10.1038/s41371-026-01127-8

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