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Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis
Open accessAbstract
BACKGROUND: There is a scarcity of published data on the global prevalence of obstructive sleep apnoea, a disorder associated with major neurocognitive and cardiovascular sequelae. We used publicly available data and contacted key opinion leaders to estimate the global prevalence of obstructive sleep apnoea. METHODS: We searched PubMed and Embase to identify published studies reporting the prevalence of obstructive sleep apnoea based on objective testing methods. A conversion algorithm was created for studies that did not use the American Academy of Sleep Medicine (AASM) 2012 scoring criteria to identify obstructive sleep apnoea, allowing determination of an equivalent apnoea-hypopnoea index (AHI) for publications that used different criteria. The presence of symptoms was not specifically analysed because of scarce information about symptoms in the reference studies and population data. Prevalence estimates for obstructive sleep apnoea across studies using different diagnostic criteria were standardised with a newly developed algorithm. Countries without obstructive sleep apnoea prevalence data were matched to a similar country with available prevalence data; population similarity was based on the population body-mass index, race, and geographical proximity. The primary outcome was prevalence of obstructive sleep apnoea based on AASM 2012 diagnostic criteria in individuals aged 30-69 years (as this age group generally had available data in the published studies and related to information from the UN for all countries). FINDINGS: Reliable prevalence data for obstructive sleep apnoea were available for 16 countries, from 17 studies. Using AASM 2012 diagnostic criteria and AHI threshold values of five or more events per h and 15 or more events per h, we estimated that 936 million (95% CI 903-970) adults aged 30-69 years (men and women) have mild to severe obstructive sleep apnoea and 425 million (399-450) adults aged 30-69 years have moderate to severe obstructive sleep apnoea globally. The number of affected individuals was highest in China, followed by the USA, Brazil, and India. INTERPRETATION: To our knowledge, this is the first study to report global prevalence of obstructive sleep apnoea; with almost 1 billion people affected, and with prevalence exceeding 50% in some countries, effective diagnostic and treatment strategies are needed to minimise the negative health impacts and to maximise cost-effectiveness. FUNDING: ResMed.
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“Using rates of obesity, race/ethnicity data, age, and regional prevalence data, it has been estimated that nearly one billion people have OSA worldwide, of which the vast majority is undiagnosed.98”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [98]
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“Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder that affects approximately 25% of adults in the US and similar amounts in other high-income countries, although estimates vary depending on its definition (Gottlieb & Punjabi, 2020;Benjafield et al., 2019).”
From Effects of mindfulness meditation and Acceptance and commitment therapy in patients with obstructive sleep apnea with residual excessive sleepiness: A randomized controlled pilot study (2023) · cites this paper as Benjafield et al., 2019
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“The high global prevalence of OSA (Benjafield et al., 2019) represents a challenge for diagnosis as the current “gold standard” diagnostic test is PSG in a sleep laboratory, which is labour intensive and expensive (Kapur et al., 2017).”
From Obstructive sleep apnea: transition from pathophysiology to an integrative disease model (2022) · cites this paper as Benjafield et al., 2019
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“It was estimated that, globally, 936 million men and women of the considered age group have at least mild OSA and 425 million have moderate‐to‐severe OSA.”
From Obstructive sleep apnea: transition from pathophysiology to an integrative disease model (2022) · cites this paper as Benjafield et al., 2019
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Metadata
- Authors
- Benjafield, A. V., Ayas, N. T., Eastwood, P. R., Heinzer, R., Ip, M. S. M., Morrell, M. J., Nunez, C. M., Patel, S. R., Penzel, T., Pépin, J.-L., Peppard, P. E., Sinha, S., Tufik, S., Valentine, K., & Malhotra, A.
- Affiliations
- ResMed (United States) (US)
- University of British Columbia (CA)
- The University of Western Australia (AU)
- Centre Hospitalier Universitaire Vaudois (CH)
- Royal Brompton & Harefield NHS Foundation Trust (GB)
- University of Pittsburgh (US)
- Charité – Universitätsmedizin Berlin (DE)
- Inserm (FR)
- University of Wisconsin–Madison (US)
- All India Institute of Medical Sciences (IN)
- University of California San Diego (US)
- Corresponding author
- Malhotra, Atul
- ORCID
- Venue
- The Lancet Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2019-08
- Volume
- 7
- Issue
- 8
- Pages
- 687-698
- ISSN
- 2213-2600 (ISSN-L)
- PMC
- PMC7007763
- OpenAlex
- W2959442417
- Cited by
- 4,326
- References
- 59
- Citations by year
- 2026: 768 · 2025: 883 · 2024: 735 · 2023: 676 · 2022: 539 · 2021: 446 · 2020: 252 · 2019: 24
- FWCI
- 37.04
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet Respiratory Medicine (publishedVersion, public-domain)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (publishedVersion)
- SERVAL (Université de Lausanne) (publishedVersion)
- PubMed Central (acceptedVersion)
- HAL (submittedVersion, other-oa)
- Murdoch University Research Portal (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- IRIS (submittedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
- Funders
- Philips
- Fondation Leenaards
- GlaxoSmithKline
- Pharmaceuticals Bayer
- ResMed
- American Thoracic Society
- National Health and Medical Research Council (1042341)
- American Sleep Medicine Foundation
- Agence Nationale de la Recherche (ANR-12-TECS-0010, ANR-15-IDEX-02)
- ResMed Foundation
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (3200B0-105993, 3200B0-118308, 33CS30-139468, 33CS30-148401, 33CSCO-122661)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- obstructive sleep apnea, global prevalence, disease burden, apnea-hypopnea index, conversion algorithm, China, United States, Brazil, India, obesity, cardiovascular risk, neuropsychological outcomes, treatment cost-effectiveness
- MeSH terms
- Adult, Aged, Asia, Europe, Female, Humans, Male, Middle Aged, South America, United States, Prevalence, Cost of Illness, Sleep Apnea, Obstructive, Internationality, Australasia
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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