The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults
Open accessAbstract
BACKGROUND: Limited data have suggested that sleep-disordered breathing, a condition of repeated episodes of apnea and hypopnea during sleep, is prevalent among adults. Data from the Wisconsin Sleep Cohort Study, a longitudinal study of the natural history of cardiopulmonary disorders of sleep, were used to estimate the prevalence of undiagnosed sleep-disordered breathing among adults and address its importance to the public health. METHODS: A random sample of 602 employed men and women 30 to 60 years old were studied by overnight polysomnography to determine the frequency of episodes of apnea and hypopnea per hour of sleep (the apnea-hypopnea score). We measured the age- and sex-specific prevalence of sleep-disordered breathing in this group using three cutoff points for the apnea-hypopnea score (> or = 5, > or = 10, and > or = 15); we used logistic regression to investigate risk factors. RESULTS: The estimated prevalence of sleep-disordered breathing, defined as an apnea-hypopnea score of 5 or higher, was 9 percent for women and 24 percent for men. We estimated that 2 percent of women and 4 percent of men in the middle-aged work force meet the minimal diagnostic criteria for the sleep apnea syndrome (an apnea-hypopnea score of 5 or higher and daytime hypersomnolence). Male sex and obesity were strongly associated with the presence of sleep-disordered breathing. Habitual snorers, both men and women, tended to have a higher prevalence of apnea-hypopnea scores of 15 or higher. CONCLUSIONS: The prevalence of undiagnosed sleep-disordered breathing is high among men and is much higher than previously suspected among women. Undiagnosed sleep-disordered breathing is associated with daytime hypersomnolence.
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The Wisconsin Sleep Cohort and SHHS found a general prevalence of 24% in men and 9% in women using the alternative hypopnea definition of ≥4% oxygen desaturation.
“These studies found a general prevalence of 24% in men, 9% in women using the alternative definition of hypopnea (≥4% oxygen desaturation).”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [90]
The Occurrence of Hypersomnolence (p. 3) gives prevalence estimates of 24% for men and 9% for women with an apnea-hypopnea score of at least 5. Interpretation of Polysomnographic Data (p. 2) defines hypopnea using a decrease of at least 4% in oxyhemoglobin saturation. These are estimates for middle-aged adults from the Wisconsin Sleep Cohort; this paper does not report an SHHS finding or establish prevalence for the general population. (LLM, conf=0.87)
Experimental — accuracy not yet measuredA smaller subset, 3%-7% in men and 2%-5% in women, had OSAS based on AHI ≥5 with excessive daytime sleepiness.
“A smaller subset, 3%–7% in men and 2%–5% in women, had OSAS based on AHI ≥ 5 with excessive daytime sleepiness.88,90,92”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [90]
The Occurrence of Hypersomnolence section (p. 3) estimates that 4% of men and 2% of women had both an apnea-hypopnea score of at least 5 and self-reported hypersomnolence. The paper supports the criterion and estimates within the quoted ranges, but it does not report the ranges of 3%–7% for men and 2%–5% for women. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAn increase in BMI by 1 standard deviation was associated with a threefold increase in risk of OSA.
“Another study showed an increase in BMI by 1 standard deviation (SD) was associated with a threefold increase in risk of OSA.90”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [90]
The Risk Factors discussion (p. 5) describes a threefold increase for a one-SD increment in any measure of body habitus. But Table 5 (p. 5) gives the BMI-specific odds ratio as 4.17, not threefold, for sleep-disordered breathing defined by an apnea-hypopnea score of at least 5. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOSA is a heterogeneous disorder with different pathways to disease.
“There are different pathways to disease, such that OSA is a heterogeneous disorder.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [90]
The Discussion (p. 4) describes a wide spectrum of sleep-disordered breathing severity, and Risk Factors (p. 5) identifies sex and obesity as risk factors. These findings support variation in the disorder, but the paper does not establish different pathways to disease. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMen are more likely than women to report snoring (34% vs. 19%).
“Sex differences in reported sleep symptoms have been reported, with men being more likely to report snoring (34% vs. 19%) and women being more likely to report hypersomnolence (22.6% vs. 15.5%).90”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [90]
Table 1 (Collection of Polysomnographic Data, p. 2) supports the direction of the sex difference: 44% of men and 28% of women were classified as habitual snorers. It does not support the attributed 34% versus 19% figures; its definition of habitual snoring also includes reported snorting or breathing pauses. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Women are more likely than men to report hypersomnolence (22.6% vs. 15.5%).
“Sex differences in reported sleep symptoms have been reported, with men being more likely to report snoring (34% vs. 19%) and women being more likely to report hypersomnolence (22.6% vs. 15.5%).90”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [90]
The Occurrence of Hypersomnolence (p. 3) reports that hypersomnolence was more common among women than men and gives the cited 22.6% and 15.5% figures. Those figures apply only to subjects with apnea-hypopnea scores of 5 or higher, a restriction the citing sentence omits. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe prevalence of an increased AHI was higher than the prevalence of EDS.
“As in the foregoing study, the prevalence of an increased AHI was higher than the prevalence of EDS.”
From Obstructive sleep apnea: transition from pathophysiology to an integrative disease model (2022) · cites this paper as Young et al., 1993
The Occurrence of Hypersomnolence section (p. 3) estimates an AHI of at least 5 in 9% of women and 24% of men, while 2% and 4%, respectively, had both that AHI and self-reported hypersomnolence. This supports a higher prevalence of increased AHI than of the combined condition, but the text does not give an overall prevalence of excessive daytime sleepiness (EDS) alone for the claimed comparison. (LLM, conf=0.82)
Experimental — accuracy not yet measuredMost population-based studies show a two- to threefold greater prevalence of OSA among men compared to women.
“Most population-based studies show a two- to threefold greater prevalence of OSA among men compared to women.18,45,90,93,96,99,104,144–156”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [90]
Obesity plays a major role in OSA.
“Obesity plays a major role.90”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [90]
The estimated prevalence of OSA, defined as an AHI of ≥5 events/h, was 24% in men and 9% in women in the Wisconsin Sleep Cohort.
“The estimated prevalence of OSA, defined as an AHI of ≥5 events/h, was found to be 24% in men and 9% in women.”
From Obstructive sleep apnea: transition from pathophysiology to an integrative disease model (2022) · cites this paper as Young et al., 1993
Based on the combined presence of EDS and an increased AHI, it was estimated that 2% of women and 4% of men met the minimal diagnostic criteria for OSA disorder.
“Based on the combined presence of EDS and an increased AHI, it was estimated that 2% of women and 4% of men met the minimal diagnostic criteria for OSA disorder.”
From Obstructive sleep apnea: transition from pathophysiology to an integrative disease model (2022) · cites this paper as Young et al., 1993
OSA affects an estimated 9% of adult women and 24% of adult men.
“It affects an estimated 9% of adult women and 24% of adult men.175”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [175]
OSAS represents approximately 4% of middle-aged men and 2% of middle-aged women.
“These represent ∼4% of middle-aged men and ∼2% of middle-aged women (26,27).”
From Quantity and Quality of Sleep and Incidence of Type 2 Diabetes (2010) · cites this paper as [26]
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- Authors
- Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., & Badr, S.
- Affiliations
- University of Wisconsin–Madison (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1993-04-29
- Volume
- 328
- Issue
- 17
- Pages
- 1230-1235
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2333343699
- Semantic Scholar
- 4305a9a6032319ffe09429f448d8786990d3f2ae
- Cited by
- 10,183
- References
- 32
- Citations by year
- 2026: 98 · 2025: 175 · 2024: 195 · 2023: 269 · 2022: 278 · 2021: 304 · 2020: 344 · 2019: 350 · 2018: 406 · 2017: 384 · 2016: 452 · 2015: 494 · 2014: 548 · 2013: 556 · 2012: 495
- FWCI
- 50.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5p01hl042242-05, 5k08hl002588-05)
- National Heart, Lung, and Blood Institute (HL 02588, P01 HL42242)
- National Center for Research Resources (RR03186)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Keywords
- sleep-disordered breathing, sleep apnea, prevalence, middle-aged adults, undiagnosed sleep apnea, apnea-hypopnea index, sex differences, obesity, snoring, excessive daytime sleepiness, Wisconsin Sleep Cohort Study
- MeSH terms
- Adult, Age Factors, Female, Humans, Disorders of Excessive Somnolence, Male, Middle Aged, Obesity, Prospective Studies, Risk Factors, Sex Factors, Sleep Apnea Syndromes, Wisconsin, Prevalence, Odds Ratio, Polysomnography
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