Sleep Apnea

First created | 05/04/2000

Last edited |

Summary by Maurice M. Ohayon, MD, DSc, PhD
Reference to cite:

  1. Ohayon MM. Epidemiology of sleep disorders in the general population. Guilleminault C (ed) Sleep and its disorders. Series Handbook of Clinical Neurophysiology, 2005.

Few surveys have estimated the prevalence of sleep apnea or obstructive sleep apnea syndrome in community-based samples.

Target population, methods, and criteria considerably varied between studies. In all cases, prevalences are estimation because it is virtually impossible to perform polysomnographic recordings on all participants. Therefore screening questionnaires were used to identify participants most likely to have sleep apnea or obstructive sleep apnea syndrome:

  • The Israeli study by Lavie (72) was one of the first to explore obstructive sleep apnea in a non-clinical sample.
    Here, 300 working men were examined, 78 of which with polysomnography. An apnea/hypopnea index (AHI) greater than or equal to 10 was found in 2.7% of the sample and an AHI greater than or equal to 20 in 0.7%.

  • In the Finnish twin cohort study, Telakivi et al. (139) carried out polysomnographic recordings on 25 snorers and 27 non-snorers selected from among 278 men aged 41 to 50 years.
    They estimated that 0.4% of this population had an AHI greater than or equal to 20 and that 1.4% had an AHI greater than or equal to 10, with an oxygenation desaturation index (ODI) of at least 4%.

  • In Sweden, Gislason et al. (38) assessed 3,201 men aged 30 to 60 years and conducted polysomnographic recordings on 61 sleepy snorers.
    They calculated that 0.9% of this population had an AHI greater than or equal to 10 and that 1.4% had an AHI greater than or equal to 20.

  • In a similar survey involving 1,505 Icelandic women 40 to 59 years old, Gislason et al. (40) found that 2.5% of the sample presented with a sleep apnea syndrome defined as daytime sleepiness with an AHI ≥30.

  • In Italy, Cirignotta et al. (25) surveyed 1,510 men aged 30 to 69 years via a postal questionnaire and selected 156 of them for polysomnography.
    They estimated that 4.8% of this population had an AHI greater than 5, and 3.2% an AHI greater than 10.

  • In Spain, Duran et al (30) interviewed 2148 individuals from the general population and performed polysomography with 555 of them.
    The prevalence of AHI>=10 was at 19% among men and 14.9% among women.

  • The Wisconsin Sleep Cohort study (154) looked at 3,513 workers aged 30 to 60 years.
    Of these, 625 habitual and non-habitual snorers were submitted to a one-night polysomnographic recording. For women, 18.9% of habitual snorers and 5% of non-habitual snorers had an AHI of 5 or greater.
    For men, the corresponding figures were 34% and 16.1%, respectively. Based on these findings, the prevalence of sleep apnea syndrome (daytime sleepiness and/or non-refreshing sleep and an AHI of 5 or greater) was estimated at 4% among men and 2% among women.

  • Two studies performed using large community based samples (15,17) screened for possible sleep breathing disorders and recorded 1741 participants.
    The prevalence of sleep apnea, defined as AHI >=10 accompanied with daytime symptoms was estimated at 3.3% among men (17) and 1.2% among women (15).

  • In Australia, the Busselton health survey (11) found that 12.2% of men aged 40 to 65 years had at least five respiratory disturbances per hour of sleep (RDI ≥5) along with "at least occasional" daytime sleepiness, and that 3.1% had an RDI greater than or equal to 5 along with daytime sleepiness "at least often".

  • Also in Australia, Olson et al. (114) queried 2,202 subjects aged 35 to 69 years and monitored 441 of these who complained about their sleep or snored.
    The rate of obstructive sleep apnea syndrome, based on an AHI of 15 or greater, was estimated at 3.6% overall, and at 5.7% for men and 1.2% for women.

  • In Hong Kong, Ip et al (57) screened 1532 women between 30 and 60 years and performed polysomnography on 106 of them.
    They reported a prevalence of AHI>= 5 at 3.7%; an AHI>= 5 accompanied with daytime sleepiness was found in 2.1% of their sample.

  • Using a similar methodology, Udwadia et al (141) screened 658 Indian men aged between 35 and 65 and performed polysomnography on 250 of them.
    They reported a prevalence of AHI>= 5 at 19.5%; an AHI>= 5 accompanied with daytime sleepiness was found in 7.5% of their sample.


Prevalence of sleep apnea in selected samples:

Prevalence of sleep apnea in selected samples
 AI= Apnea index; AHI= Apnea/hypopnea index; ODI=Oxygen desaturation index; RDI=Respiratory disturbance index
Authors Population N(n recorded) Age Methods Criteria Prevalence(%)
Lavie (72)
Israel, 1983 		Male workers 1502 (78) 32-67 1) Questionnaire
2) Polysomnography 		AI ≥ 10 0.89
Israel, 1983
Uppsala , Sweden, 1988 		Men, general population 3201 (61) 30-69 1) Postal questionnaire
2) Polysomnography, sleepy 		AI ≥ 30 + daytime sleepiness 1.3
Cirignotta et al. (25)
Bologna, Italy, 1989 		Men, general population 1170 (40) 30-69 1) Postal questionnaire
2) Polysomnography, every-night snorers 		AI ≥ 10 2.7
Martikainen et al. (84)
Tempere, Finland, 1994 		General population 1985: 1190
1990: 626 (22)		 36-50 1) Postal questionnaire
2) Polysomnography, habitual male snorers 		ODI ≥ 4% > 5 per hour
ODI ≥ 4% > 10 per hour 		1.8
1.1
Ancoli-Israel et al. (2)
San Diego,USA, 1991 		General population 615 (427) 65-95 Home Polysomnography AI ≥ 5
RDI ≥ 10		 24.0
62.0
Stradling & Cosby (136)
Oxford, UK, 1991 		Men, age-sex register of one group general practice 1001 (893) 35-65 Oximetry ODI ≥ 4% > 5 per hour
ODI ≥ 4% > 10 per hour
ODI ≥ 3% > 10 per hour 		5.0
1.0
0.8
Gislason et al. (40)
Reykjavik, Iceland, 1993 		Women, general population 1505 (35) 40-59 1) Postal questionnaire
2) Polysomnography, sleepy snorers 		AHI ≥ 30 + daytime sleepiness 2.5
Young et al. (154)
USA, 1993 		State employees 3513 (625) 30-60 1) Questionnaire
2) Polysomnography, snorers 		AHI ≥ 5 + daytime sleepiness or non-refreshing sleep 4.0 (M)
2.0 (W)
Olson et al (114)
Australia, 1995 		General population 2202 (441) 35-69 1) Questionnaire
2) repiratory measurment, overrepresentation of snorers and sleep complainers 		AI ≥ 10 5.7 (M)
1.2 (W)
Bearpark et al. [(11)
Busselton, Australia, 1995 		Men, general population 486 (294) 40-65 1) Questionnaire
2) Polysomnography 		RDI ≥ 5 + at least occasional daytime sleepiness
RDI ≥ 5 + at least often daytime sleepiness 		12.2
3.1
Bixler et al. (17)
Pennsylvania, USA, 1998 		Men, general population 4364 (741) 20-100 1) Telephone interview
2) Polysomnography 		AI ≥ 10 + daytime symptoms 3.3
Bixler et al. (15)
Pennsylvania, USA, 2001 		Women, general population 12,219 (1000) 20-100 1) Telephone interview
2) Polysomnography 		AI ≥ 10 + daytime symptoms 1.2
Duran et al. (30)
Vitoria-Gasteiz, Spain, 2001 		Men and women, general population 2148 (555) 30-70 1) Home interview
2) Portable respiratory recording
3) Polysomnography 		AI ≥ 10 19.0 (M)
14.9 (W)
Ip et al. (57)
Hong Kong, 2004 		Women, general population 1532 (106) 30-60 1) Questionnaire
2) Polysomnography 		AI ≥ 5
AHI ≥ 5 + excessive daytime sleepiness		 2.1
Udwadia et al. (141)
Bombay, India, 2004 		Men, general population 658 (250) 35-65 1) Questionnaire
2) Polysomnography 		AI ≥ 5
AHI ≥ 5 + excessive daytime sleepiness		 19.5
7.5

REFERENCE

Content of this page is extracted from:
Ohayon MM. Epidemiology of sleep disorders in the general population. Guilleminault C (ed) Sleep and its disorders. Series Handbook of Clinical Neurophysiology, 2005.