Obstructive Sleep Apnea Could Affect Nearly 1 Billion Globally

Atul Malhotra, MD

The global prevalence of obstructive sleep apnea (OSA) is now estimated to near 1 billion people—and that total may still be understated.

A potentially first-of-its-kind assessment of published prevalence studies and equivalency indexes has led a team of investigators to estimate that mild to severe OSA affects approximately 936 million adults aged 30-69 years old across the world.

The study findings depict a novel perspective of country-to-country burden with OSA, and adds to the growing call for improved diagnostic and treatment strategies for affected patients.

Investigators used publicly available data and perspective from key opinion leaders and experts in the field of OSA to compile prevalence studies while also creating a conversion algorithm for a standardized OSA diagnostic criteria. They sought to combat what they have found to be a scarcity of published data on what’s become a highly prevalent disease.

“There’s a lot of people being affected, yet very few studies available from a global perspective,” corresponding author Atul Malhotra, MD, of the University of California San Diego, told MD Magazine®.

Because of the scarcity of information regarding patient symptoms, investigators did not specifically analyze for symptoms. Rather, they sought a primary outcome of adult OSA global prevalence as per the American Academy of Sleep Medicine (AASM) 2012 diagnostic criteria.

Their assessment focused on adults aged 30-69 years old, as this age group most often had available data from published studies and information related to the United Nations (UN).

Just 16 countries, from 17 studies, provided reliable OSA prevalence data. Based on the AASM diagnostic criteria—and apnea-hypopnea index (AHI) threshold values for OSA-related events—Malhotra and colleagues estimated 936 million adults (95% CI: 903-970) were affected with mild to severe forms of the disease.

Another 425 million adults (95% CI: 399-450) were estimated to have moderate to severe OSA globally. Among observable countries, China—followed by the US, Brazil, and India—was the most burdened by OSA.

The team concluded their findings were the first to their knowledge to report global prevalence of OSA. Not only did their count near 1 billion, it indicated that prevalence could exceed 50% in some countries.

Though estimations and algorithms were necessary to generate the global totals, Malhotra said the findings were greater than anticipated. He cited the obesity epidemic—a public health issue well-documented in the US, but equally burdensome in lesser-developed and -documented countries—as a key driver in the OSA rates.

As such, the burden may only grow.

“We need to think of strategies to address this global burden through new protocol for diagnosis and treatment,” he said.

Malhotra expressed hope technological solutions develop to address current lapses in OSA diagnoses and screening. Though current clinical questionnaires are helpful for screening purposes, they’re certainly not robust enough to help actual diagnoses.

What may come is an embrace of wearable technology, blood tests, or other advances in diagnostics—all of which may help clinicians more concisely identify and treat OSA.

The study, “Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis,” was published online in The Lancet Respiratory Medicine.