Underdiagnosis of Sleep Apnea Syndrome in U.S. Communities

Abstract

We hypothesize that clinical recognition rates for obstructive sleep apnea-hypoapnea syndrome (OSAHS) are influenced by comorbidity and demographic factors. Data on medical disorders, symptoms of sleep disorders, and cardiovascular risk factors gathered from 15,699 individuals in the Sleep Heart Health Study were compared. Participants were classified into three groups: those with a self-reported physician diagnosis of OSAHS, those with self-reported physician-diagnosed and -treated OSAHS, and those reporting both frequent snoring and daytime sleepiness (two-symptom group). Among all participants, 4.1% reported two symptoms (range across sites: 1.55 to 7.23%), whereas 1.6% reported a physician diagnosis of OSAHS (range: 0.66 to 2.88%) and 0.6% reported physician diagnosis and treatment (range: 0.11 to 0.88%). Recognized OSAHS groups were similar to the two-symptom group in age, having a sleeping partner, measured blood pressure, total cholesterol, and race. In a logistic model that included age along with characteristics found to vary significantly among the three groups (gender, body mass index [BMI], high-density lipoprotein cholesterol levels, hypertension), only male gender and BMI were increased in those with physician-diagnosed and -treated OSAHS. We conclude that disparities (especially in women and in those with lower BMI) exist between current recognition rates for OSAHS and the estimated prevalence by symptom report across the United States.

Sleep Apnea and Cardiovascular Disease

“…41 However, Ͼ85% of patients with clinically significant and treatable OSA have never been diagnosed, and referral populations of OSA patients represent only the "tip of the iceberg" of OSA prevalence. 42,43 In addition to emphasizing the large burden of untreated OSA in the general population, the low level of medical detection demands caution in generalizing observations of OSA patients diagnosed in sleep clinics to cardiovascular disease patients with occult OSA. Understanding predictors of OSA free from sleep clinic referral bias is necessary to recognize cardiovascular disease patients likely to have OSA.…”

Driving Simulator Performance Remains Impaired In Patients With Severe OSA after CPAP Treatment

“…[1][2][3][4][5][6][7][8][9] Community surveys have shown that OSA affects approximately 7% of the middle-aged population, [10][11][12] with as many as 80% of those affected being undiagnosed. [13][14][15] Thus, OSA presents a serious public health concern with respect to road safety.…”

The Determining Risk of Vascular Events by Apnea Monitoring (DREAM) study: design, rationale, and methods

“…In the U.S., obesity and OSA are both on the rise. But only about 20% of OSA is diagnosed, and even a smaller percentage is effectively treated [27][28][29][30]. OSA is a well-known independent risk factor for a variety of diseases related to cardiovascular disease, including hypertension, diabetes, cardiac arrhythmia, stroke, and coronary heart disease [5,8,9,14,31].…”