Prevalence of Sleep Apnea on the rise

[Captain_Midnight]

Here's an interesting abstract from PubMed that predicts that sleep disordered breathing (as indicated by AHI) is substantially more prevalent in the population than a few decades back.

My one quibble is that the authors use the nonsensical >15 events/hr metric, which most of us know from personal experience to be way too high (as it excludes too many folks with frank symptoms who fall below 15 events/hr).

The following abstract from http://www.ncbi.nlm.nih.gov/pubmed/23589584

Peppard PE, et al., Increased Prevalence of Sleep-Disordered Breathing in Adults, Am J Epidemiol. 2013 Apr 14

Sleep-disordered breathing is a common disorder with a range of harmful sequelae. Obesity is a strong causal factor for sleep-disordered breathing, and because of the ongoing obesity epidemic, previous estimates of sleep-disordered breathing prevalence require updating. We estimated the prevalence of sleep-disordered breathing in the United States for the periods of 1988-1994 and 2007-2010 using data from the Wisconsin Sleep Cohort Study, an ongoing community-based study that was established in 1988 with participants randomly selected from an employed population of Wisconsin adults. A total of 1,520 participants who were 30-70 years of age had baseline polysomnography studies to assess the presence of sleep-disordered breathing. Participants were invited for repeat studies at 4-year intervals. The prevalence of sleep-disordered breathing was modeled as a function of age, sex, and body mass index, and estimates were extrapolated to US body mass index distributions estimated using data from the National Health and Nutrition Examination Survey. The current prevalence estimates of moderate to severe sleep-disordered breathing (apnea-hypopnea index, measured as events/hour, ≥15) are 10% (95% confidence interval (CI): 7, 12) among 30-49-year-old men; 17% (95% CI: 15, 21) among 50-70-year-old men; 3% (95% CI: 2, 4) among 30-49-year-old women; and 9% (95% CI: 7, 11) among 50-70 year-old women. These estimated prevalence rates represent substantial increases over the last 2 decades (relative increases of between 14% and 55% depending on the subgroup).

.

[Oneeyedjack]

Think maybe because people hear about sleep apnea a lot more than they did 15-20 years ago so there are many more people going in to get tested. Finally got my dad to get tested. He has been a big snorer since I was a kid and had never heard of sleep apnea until I was diagnosed and thought so what I snore, big deal. Well he got tested and had severe sleep apnea. Seems now everybody knows somebody on the mask, all the cool kids are doing it

[DreamStalker]

Think maybe because people hear about sleep apnea a lot more than they did 15-20 years ago so there are many more people going in to get tested. Finally got my dad to get tested. He has been a big snorer since I was a kid and had never heard of sleep apnea until I was diagnosed and thought so what I snore, big deal. Well he got tested and had severe sleep apnea. Seems now everybody knows somebody on the mask, all the cool kids are doing it

I agree. Perhaps prevalence is not so much on the rise as is diagnosis.

I'm pretty sure my dad had severe OSA, loud snoring and stopped breathing every time he fell asleep on the couch. He was never diagnosed and I'm pretty sure I had it for 25+ years and never knew what OSA was until I was diagnosed.

[Captain_Midnight]

D.S. and O.E.J., your points are good ones, and most certainly the percentage of folks getting studies is increasing - just as you suggest.

The study, however, is an epidemiological one based on modeled estimates, and the pool of original participants was selected randomly (if we are to believe the abstract).

Epi studies often base much of their conclusions on a series of assumptions followed by mathematical treatment. In this case, the authors cite the "obesity" epidemic for their assumptions.

That said, I still take issue with the prevailing consensus of "moderate to severe sleep-disordered breathing (apnea-hypopnea index, measured as events/hour, ≥15". One hopes that this arbitrary mythical standard will eventually be lowered as we patients self-report significant symptoms vs. events/hour at much lower AHIs.

.

[Wulfman...]

I'm going to disagree with the premise and part of the supposition.

I think the higher numbers of people being diagnosed is because there's more awareness of it.
More doctors have been educated to recognize the related signs (high blood pressure, obesity, diabetes)
More people are getting diagnosed and more seem to be "willing" to go through the sleep study processes.
For all intents and purposes, "Sleep Apnea" is a very new niche of medicine (and a very lucrative source of income for many).
It only makes sense that "the more you look, the more you find".

I really disagree with this statement:

Obesity is a strong causal factor for sleep-disordered breathing.......

I believe obesity is more of a RESULT of sleep apnea and not a cause. Sure, there may be some that it applies to, but I think the majority of the time, sleep apnea (and poor sleep in general) precedes the weight gain. How many people have we seen posting on the forum who have said they are of "normal" weight or even thin?
I also believe that for many people, the origin of the problem is in their nasal passages......enlarged turbinates and/or deviated septum.

Just my 2 ¢ worth.


Den

.

[Captain_Midnight]

Hi Den! How are you? Always good to hear from one of the old (relatively, of course) gang.

I agree w you, that obesity does not always cause OSA; (as one of normal weight myself, and one who has had this all his life, I am an example of what you write.).

The authors make the assumption that since there is more obesity, there must be more OSA, and try to put a numerical percentage on that increase.

Lost is the notion that in many cases, OSA of a normal weight person lead to hormone changes which lead to obesity (which made the OSA and thus, the obesity even worse.) If we were to separate out all of the non-obese OSA patients who later became obese, then we would be in the realm of what the authors looked at, at least that's what it appears to be from the abstract.

I love the discussion as I don't think that the researchers in the field are focused enough on the young folks who have the disorder; and might have it at sub-therapeutic action levels (there's that >15 AHI foolishness, again.)

Stay well! -- Tom


.

[Wulfman...]

Hi Tom.

Doin' OK.

You stay well, too.

Den

.