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Lancet Respir Med. 2019 Aug;7(8):687-698. doi: 10.1016/S2213-2600(19)30198-5. Epub 2019 Jul 9.

Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis.

Author information

1
ResMed Science Center, San Diego, CA, USA.
2
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
3
Centre for Sleep Science, School of Human Sciences, University of Western Australia, and Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia.
4
Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland.
5
Department of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China.
6
National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
7
Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
8
Charité - Universitätsmedizin Berlin, Berlin, Germany.
9
HP2 Laboratory, INSERM U1042, Univ. Grenoble Alpes, and EFCR laboratory, Grenoble Alpes University Hospital, Grenoble, France.
10
Department of Population Health Sciences, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.
11
All India Institute of Medical Sciences, New Delhi, India.
12
Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
13
University of California San Diego, La Jolla, CA, USA. Electronic address: amalhotra@ucsd.edu.

Abstract

BACKGROUND:

There is a scarcity of published data on the global prevalence of obstructive sleep apnoea, a disorder associated with major neurocognitive and cardiovascular sequelae. We used publicly available data and contacted key opinion leaders to estimate the global prevalence of obstructive sleep apnoea.

METHODS:

We searched PubMed and Embase to identify published studies reporting the prevalence of obstructive sleep apnoea based on objective testing methods. A conversion algorithm was created for studies that did not use the American Academy of Sleep Medicine (AASM) 2012 scoring criteria to identify obstructive sleep apnoea, allowing determination of an equivalent apnoea-hypopnoea index (AHI) for publications that used different criteria. The presence of symptoms was not specifically analysed because of scarce information about symptoms in the reference studies and population data. Prevalence estimates for obstructive sleep apnoea across studies using different diagnostic criteria were standardised with a newly developed algorithm. Countries without obstructive sleep apnoea prevalence data were matched to a similar country with available prevalence data; population similarity was based on the population body-mass index, race, and geographical proximity. The primary outcome was prevalence of obstructive sleep apnoea based on AASM 2012 diagnostic criteria in individuals aged 30-69 years (as this age group generally had available data in the published studies and related to information from the UN for all countries).

FINDINGS:

Reliable prevalence data for obstructive sleep apnoea were available for 16 countries, from 17 studies. Using AASM 2012 diagnostic criteria and AHI threshold values of five or more events per h and 15 or more events per h, we estimated that 936 million (95% CI 903-970) adults aged 30-69 years (men and women) have mild to severe obstructive sleep apnoea and 425 million (399-450) adults aged 30-69 years have moderate to severe obstructive sleep apnoea globally. The number of affected individuals was highest in China, followed by the USA, Brazil, and India.

INTERPRETATION:

To our knowledge, this is the first study to report global prevalence of obstructive sleep apnoea; with almost 1 billion people affected, and with prevalence exceeding 50% in some countries, effective diagnostic and treatment strategies are needed to minimise the negative health impacts and to maximise cost-effectiveness.

FUNDING:

ResMed.

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