Higher OSAS.MAP10 scores showed a nonlinear association with all-cause mortality among hypertensive adults aged ≥60 years, but the increase above approximately 6.2 was observed only without continuous age adjustment and was attenuated thereafter, making this inflection point hypothesis-generating rather than clinically actionable.
Key Findings
Results
Among hypertensive adults aged ≥60 years, the OSAS.MAP10-mortality association was nonlinear with a statistically significant threshold near 6.19.
Analysis included 3,982 participants aged ≥60 years with 1,006 deaths in the complete-case analysis
P for nonlinearity <0.001
In the age-stratified model without continuous age adjustment, each 1-point increase at or above 6.19 was associated with higher mortality (HR 1.21; 95% CI 1.02–1.44; p = 0.029)
Below the inflection point of approximately 6.2, the risk of death appeared stable
Results
The association between OSAS.MAP10 score and all-cause mortality above the 6.19 threshold was substantially attenuated after additional continuous age adjustment.
After adding continuous age as a covariate to the age-stratified model, the HR dropped from 1.21 to 0.96 (95% CI 0.83–1.12; p = 0.643)
The attenuation indicates the threshold finding is model-dependent
Authors describe the 6.2 inflection point as 'exploratory' and 'model-dependent' rather than a clinical cut-off
The paper states this finding 'requires validation in an independent cohort'
Methods
Among the full cohort of 6,930 hypertensive adults, 1,199 total deaths occurred over the study follow-up period.
Data came from NHANES 2005–2008 and 2015–2018 cycles
Primary outcome was all-cause mortality; cardiovascular and cancer mortality were secondary outcomes
Follow-up extended up to 11 years
Survey-weighted Cox proportional hazards models were used with restricted cubic splines to assess nonlinearity
Results
Cardiovascular mortality showed no significant nonlinear association with OSAS.MAP10 scores.
Cardiovascular and cancer mortality were pre-specified secondary outcomes
No significant nonlinearity was detected for the cardiovascular mortality endpoint
The nonlinear pattern was specific to all-cause mortality in the ≥60 age group
Results
No clear OSAS.MAP10 threshold association with mortality was observed in participants younger than 60 years or among adults without hypertension.
The age-stratified analysis identified the nonlinear pattern only in those aged ≥60 years
The study population was restricted to hypertensive adults, so the finding does not generalize to normotensive individuals
Authors note 'no such clear threshold was seen in younger people or those without high blood pressure'
Methods
Covariates adjusted for in the multivariable models included age, sex, race and ethnicity, BMI, education, family poverty income ratio, smoking status, diabetes, baseline cardiovascular disease, current antihypertensive medication use, and survey period.
OSAS.MAP10 is described as 'a symptom-based screening score estimating OSA risk, not a polysomnographic severity measure'
The score ranges from 0 to 10 points
The primary model in adults ≥60 years used age stratification without continuous age; continuous age adjustment was evaluated as a sensitivity analysis
Survey-weighted analyses were conducted to account for the complex NHANES sampling design
What This Means
This research suggests that among older adults (aged 60 and above) who have high blood pressure, a simple 10-question screening tool for sleep apnea risk called OSAS.MAP10 may be linked to the risk of dying over the following years. Using data from nearly 7,000 U.S. adults followed for up to 11 years through the national NHANES survey, the researchers found that the relationship between this score and mortality was not a simple straight line — instead, risk appeared relatively stable up to a score of about 6.2, with a possible uptick above that level. However, this finding was only present in one particular statistical model that did not include continuous age as a variable, and when age was added back in, the association largely disappeared.
This means the apparent 'danger threshold' of 6.2 is sensitive to how age is handled in the analysis, making it an exploratory finding rather than an established clinical marker. The researchers found no similar pattern for cardiovascular or cancer deaths specifically, nor in younger hypertensive adults. The study is observational, meaning it can show statistical associations but cannot prove that the OSAS.MAP10 score itself causes death, or that treating sleep apnea would reduce mortality risk.
This research suggests the OSAS.MAP10 tool might one day help identify older hypertensive patients who could benefit from further sleep evaluation, but the authors are careful to note that this specific threshold has not been validated in other datasets and should not currently guide clinical decisions such as referrals for sleep testing. Further independent studies are needed before any practical application can be considered.
Shen X, Huang P, Luo Y, Xie Q. (2026). OSAS.MAP10 and all-cause mortality risk in hypertensive patients: a retrospective cohort analysis of NHANES.. Blood pressure. https://doi.org/10.1080/08037051.2026.2721754