Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms

Arnardóttir, Erna Sif; Björnsdóttir, Erla; Olafsdottir, Katrin; Benediktsdóttir, Bryndís; Gíslason, Þórarinn

doi:10.1183/13993003.01148-2015

Cited by 205 publications

(149 citation statements)

References 35 publications

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“…Another population-based study performed in Iceland found that approximately 20% of subjects had moderate to severe OSA and were largely asymptomatic. 11 Together, these studies suggest that the cutoffs for treatment of OSA may need to be adjusted further upward from the current AHI cutoff of 15. 17 In that context, ruling out severe OSA in a general population setting may be more clinically relevant.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] Second, OSA subjects in the general population are usually asymptomatic or have unrecognized symptoms, meaning they are less likely to present to a healthcare provider for further evaluation. 11 Hence, screening questionnaires could be particularly useful in risk stratifying large numbers of subjects in an unselected community-based population for further diagnostic testing.…”

Section: Introductionmentioning

confidence: 99%

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Using the Berlin Questionnaire to Predict Obstructive Sleep Apnea in the General Population

Tan

Yin

Tan

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: The Berlin questionnaire is a self-administered questionnaire that was developed to identify subjects with obstructive sleep apnea (OSA) in primary care settings. This study evaluated the performance of the questionnaire to predict OSA in the general population. Methods: A sample of 242 subjects in a population-based cohort completed a home-based sleep study with an Embletta device (type 3 monitor). Subjects completed the Berlin questionnaire on the evening just prior to the sleep study. The sleep studies were manually scored according to the 2012 American Academy of Sleep Medicine (AASM) criteria. Results: The prevalence of moderate-to-severe and severe OSA defined as apnea-hypopnea index (AHI) of ≥ 15 and ≥ 30 was 28.1% and 10.7%, respectively. Seventy-nine subjects (32.6%) were classified as high risk according to the Berlin questionnaire. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the questionnaire to predict an AHI ≥ 15 was 58.8%, 77.6%, 82.9%, and 50.6%, respectively. The area under the receiving operator characteristic (ROC) curve for moderate-to-severe OSA was 0.682. When used to predict an AHI ≥ 30, the sensitivity of the questionnaire increased to 76.9% with a small drop in specificity to 72.7%. The corresponding NPV, PPV, and area under the ROC curve of the questionnaire to predict severe OSA were 96.3%, 25.3%, and 0.748, respectively. Conclusions: The Berlin questionnaire may have utility in the general population setting as a screening tool for OSA in view of its good sensitivity and high NPV in ruling out severe OSA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Using the Berlin Questionnaire to Predict Obstructive Sleep Apnea in the General Population

Tan

Yin

Tan

et al. 2017

Journal of Clinical Sleep Medicine

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“…In the present study by ARNARDOTTIR et al [1], no association was found between sleepiness and OSA, whereas an effect on performance was found only in those with an AHI ⩾30. This is consistent with other population samples that have reported that only one out of five people with OSA complain of sleepiness [18][19][20].…”

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confidence: 44%

“…ARNARDOTTIR et al [1] from the University Hospital of Iceland studied a large general population sample of middle-aged individuals using polysomnographic sleep recordings, questionnaires and the psychomotor vigilance test (PVT). Of the 415 subjects, 12.5% had moderate obstructive sleep apnoea (OSA; AHI between 15 and 30), 2.9% had severe OSA (AHI ⩾30), and 3.6% were already diagnosed and treated for OSA.…”

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confidence: 99%

Moderate sleep apnoea: a “silent” disorder, or not a disorder at all?

et al. 2015

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@ERSpublications New ERJ study adds to the evidence casting doubt on the utility of recommended cut-offs for sleep apnoea treatment http://ow.ly/VgjBLMost sleep clinicians and scientists will agree that if a patient with sleep apnoea is symptomatic and has an apnoea/hypopnea index (AHI) of more than 15 events per hour, he or she deserves treatment. However, there is a large group of patients with mild and moderate sleep apnoea who are asymptomatic. For these individuals, the decision of when to treat is a grey area, and current guidelines leave clinicians wondering what to do.ARNARDOTTIR et al.[1] from the University Hospital of Iceland studied a large general population sample of middle-aged individuals using polysomnographic sleep recordings, questionnaires and the psychomotor vigilance test (PVT). Of the 415 subjects, 12.5% had moderate obstructive sleep apnoea (OSA; AHI between 15 and 30), 2.9% had severe OSA (AHI ⩾30), and 3.6% were already diagnosed and treated for OSA. Interestingly, no relationship was found between AHI and subjective sleepiness or clinical symptoms, whereas a relationship with objective vigilance, as measured by the PVT, was found only with those with AHI ⩾30. Furthermore, subjects with moderate or severe OSA were not more likely to have cardiometabolic disease than subjects with no or mild OSA. These results raise the question of whether the current cut-off of AHI ⩾15 as a sole criterion is appropriate for diagnosis and treatment of OSA.In 1998, we first reported, using the Penn State Adult Cohort, a different frequency and pattern of prevalence of OSA based on AHI solely versus based on a combination of AHI and presence of clinical symptoms (i.e. sleepiness and/or cardiometabolic disorders) [2]. The prevalence of OSA based on AHI alone was two to three times the prevalence of OSA based on laboratory and clinical criteria. Furthermore, based on AHI alone, the prevalence of OSA increased linearly, reaching its peak at very old age, whereas the prevalence based on combined criteria peaked at the age of 55 years for men and 65 years for women, then declined steeply ( figure 1) [2, 3]. In addition, oxygen desaturation in older individuals was significantly less compared to that in younger individuals, suggesting the possibility that OSA in the elderly is less severe. Together, these findings suggested that the sleep field should re-evaluate the current criteria for diagnosis and treatment in this age group. These early observations were further strengthened by another report in the same large cohort on the association of hypertension and OSA. We reported that AHI, controlled for relevant confounding variables, was independently associated with hypertension [4]. In addition, this study confirmed that the strength of the association between AHI and blood pressure was strongest in the youngest (figure 2). These findings further supported the implication that OSA in older individuals is not an independent risk factor for hypertension.

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“…Obstructive sleep apnoea syndrome (OSA) is highly prevalent with recent epidemiological reports indicating prevalence for moderate or severe sleep disordered breathing (SDB) of up to 50% in the general male population, although the prevalence of a clinically significant syndrome is considerably less (1,2). Cardiovascular co-morbidity is also common among patients with OSA, and many reports have indicated an independent relationship between OSA and various cardiovascular diseases, especially systemic hypertension (3).…”

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confidence: 99%

Continuous positive airway pressure therapy and cardiovascular outcomes in obstructive sleep apnoea syndrome: where are we now?

McNicholas¹

2016

J. Thorac. Dis.

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Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms

Cited by 205 publications

References 35 publications

Using the Berlin Questionnaire to Predict Obstructive Sleep Apnea in the General Population

Using the Berlin Questionnaire to Predict Obstructive Sleep Apnea in the General Population

Moderate sleep apnoea: a “silent” disorder, or not a disorder at all?

Continuous positive airway pressure therapy and cardiovascular outcomes in obstructive sleep apnoea syndrome: where are we now?

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