SUN-581 Assessing Mortality Trends of Sleep Apnea as an Emerging Risk Factor for Diabetes in Adults Aged 25 and Older: A Nationwide Analysis (1999-2023)

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Abstract Disclosure: A. Ahmed: None. H. Ahmad: None. M. Ali: None. F. Ahmed: None. S. abid: None. H. Irfan: None. H.A. Mehdi: None. M. Hamza: None. S. Joshi: None. S. Eltawansy: None. Background: Sleep apnea (SA) is an underrecognized yet growing public health concern in the United States with significant metabolic consequences. Emerging evidence suggests a bidirectional relationship between sleep apnea and diabetes mellitus (DM), with intermittent hypoxia and sleep fragmentation driving insulin resistance, systemic inflammation, and dysmetabolism. Despite these pathophysiological links, the impact of SA on DM-related mortality remains poorly quantified on a national scale. Methods: We analyzed CDC multiple cause of death data (1999-2023) to examine SA (ICD G47.3) and DM (ICD E10-E14)-related mortality in the U.S. adults aged 25+. Age-adjusted mortality rates (AAMRs) per million were assessed, and Joinpoint regression was used to determine trends, average annual percentage change (AAPC), and p value. Results: Between 1999 and 2023, 109,829 deaths were attributed to SA and DM. The overall AAMR surged by 827.5% (3.6 to 33.39; AAPC: 9.46, 95% CI: 9.008-10.205, p < 0.000001). Men exhibited nearly twice the AAMR of women (24.84 vs. 12.34), yet women experienced a steeper increase (778% vs. 664%). Among males, AAMR rose from 6.22 to 47.56 (AAPC: 9.71, 95% CI: 9.24-10.41, p < 0.000001), while in females, it escalated from 2.46 to 21.6 (AAPC: 9.04, 95% CI: 8.51-9.92, p < 0.000001). Racial disparities were evident, with Black individuals having the highest AAMR (23.16), followed by Whites (18.69) and Hispanics (11.61). However, the sharpest rise occurred among Whites (AAPC: 9.96, 95% CI: 9.58-10.53, p < 0.000001), followed by Blacks (AAPC: 8.39, 95% CI: 7.41-10.11, p < 0.000001). Regional variability was striking, with the Midwest experiencing the highest mortality, marked by a 900% increase in AAMR (4.17 to 41.7), followed by the West (824% increase, 4.17 to 38.51). The Midwest also recorded the most rapid escalation (AAPC: 9.91, 95% CI: 9.32-10.84, p < 0.000001). States with the highest AAMRs were Oregon (71.16), Wyoming (63.7), and Minnesota (58.91), with the first two in the West and the latter in the Midwest. Rural vs. Urban trends revealed a stark contrast, with rural areas exhibiting a 1,045% surge in AAMR (4.06 to 46.49; AAPC: 11.95, 95% CI: 11.20-13.08, p < 0.000001), compared to an 839% increase in urban areas (3.49 to 32.77; AAPC: 10.71, 95% CI: 10.14-11.58, p < 0.000001). Age-specific trends showed the most alarming rise in mortality among individuals aged 75+, with an AAPC of 12.70 (95% CI: 12.29-13.34, p < 0.000001), underscoring an urgent public health concern. Conclusion: SA and DM-related mortality have surged dramatically over the past 25 years, with the highest burden in older adults, rural populations, and the Midwest. Racial and sex disparities persist, highlighting an urgent need for targeted public health interventions. Presentation: Sunday, July 13, 2025

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