Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis.
Level 1 - systematic review of randomized trials
Systematic review and statistical modeling of objective prevalence studies (design analogy)
PubMed 31300334 · doi:10.1016/S2213-2600(19)30198-5
What was done
Authors searched PubMed and Embase for published studies reporting obstructive sleep apnoea (OSA) prevalence based on objective diagnostic testing. They developed a conversion algorithm to standardize diagnostic thresholds to the American Academy of Sleep Medicine (AASM) 2012 criteria (apnea-hypopnea index [AHI] ≥5 and ≥15 events per hour) for adults aged 30–69 years. Countries lacking primary prevalence data were matched to reference countries based on body-mass index, race, and geographic proximity to extrapolate global and national estimates.
What was found
Reliable prevalence data were identified from 17 studies across 16 countries. Globally, an estimated 936 million (95% CI 903–970) adults aged 30–69 years had mild-to-severe OSA (AHI ≥5), and 425 million (95% CI 399–450) had moderate-to-severe OSA (AHI ≥15). The highest total counts of affected individuals were found in China, followed by the USA, Brazil, and India, with prevalence exceeding 50% in certain countries.
Why it matters
This study provides the first standardized global estimates of obstructive sleep apnea, establishing that nearly one billion adults may be affected and underscoring a substantial worldwide burden on healthcare systems.
Limits
Direct prevalence data existed for only 16 countries, requiring heavy imputation and proxy matching for the rest of the world. Clinical symptoms (such as daytime somnolence) were omitted due to lack of reporting in source datasets, meaning figures reflect polysomnographic criteria rather than symptomatic disease. The analysis was restricted to individuals aged 30–69 years and was funded by an industry manufacturer (ResMed).
Cited by
- supports Approximately 1 billion people globally have sleep apnea.