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OSA may affect nearly 1 billion adults worldwide

New estimates indicate that nearly 1 billion adults around the world have mild to severe obstructive sleep apnea, about half of whom have moderate to severe disease, according to a study published in The Lancet Respiratory Medicine.

To estimate the global prevalence of OSA, the researchers analyzed 17 studies that reported the prevalence of OSA using objective testing methods. They also developed a conversion algorithm that allowed determination of an equivalent apnea-hypopnea index (AHI) for studies that did not use American Academy of Sleep Medicine (AASM) 2012 scoring criteria to identify OSA. For countries without OSA data, the researchers matched prevalence data to those of a similar country, which was determined using population BMI, race and geographical proximity.

The analyses included only people aged 30 to 69 years.

Data were available on the prevalence of OSA for 16 of 193 countries. When characterizing OSA using an AHI criterion of at least five events per hour as well as the AASM 2012 criteria, the estimated number of people aged 30 to 69 years with mild to severe OSA around the world was 936 million. When using the AHI criteria of at least 15 events, the estimated number of people with moderate to severe disease was 425 million. Results from the logistic regression model also showed that an estimated 730 million people worldwide had OSA, as defined by an AHI of at least five events.

Notably, estimates were lower when using the AASM 2007 criteria and highest when using the AASM 1999 criteria, according to the data.

China had the highest prevalence of OSA, followed by the United States, Brazil and India. Pakistan, Russia, Nigeria, Germany, France and Japan were also in the top 10, with researchers noting that the numbers reflect the countries’ population size.

The high prevalence of OSA, coupled with adverse outcomes associated with the disease, such as cardiovascular disease morbidity and mortality, indicates the need for greater education and awareness of OSA, according to the researchers. They also noted that further studies are necessary, particularly in countries where evidence on OSA prevalence is lacking.

They study did have limitations, as explained by Ludger Grote, MD, PhD, from the Sleep Disorders Center at Sahlgrenska University Hospital and the Center for Sleep and Wake Disorders at Sahlgrenska Academy at Gothenburg University in Sweden, in a linked comment. For instance, he wrote the estimates of OSA prevalence depend on the studies included and the assumptions of the calculation model used in the analysis.

Nevertheless, Grote noted, these data cast light on other research questions, such as the impact of OSA on a person’s life and overall health.

“In adults, apneas and hypopneas during sleep are in part physiological and the thresholds to pathology might vary across the lifespan. So where should we draw the line between physiology and pathology? What phenotype of sleep apnea needs clinical attention and therapy?” Gote wrote. “Indeed, the research community has started to define phenotypes and more distinct clinical stages of sleep apnea. New pathophysiological insights could lead to identification of subgroups with sleep apnea at greater risk and personalized treatment options. In the face of global prevalence estimates for sleep apnea presented by Benjafield and colleagues, the research community has received another wake-up call.” – by Melissa Foster

Disclosures: This study was sponsored by ResMed. Grote reports he has received grants, non-financial support and speakers bureau and research project support from AstraZeneca, Bayer, Desitin, Itamar Medical, Philips and Resmed; and he holds a patent on sleep apnea therapy.