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The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults
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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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measured
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
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“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]
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In the citing paper
“Obesity plays a major role.90”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [90]
The cited source says what the claim attributes to it.
In the citing paper
“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
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In the citing paper
“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
In the citing paper
“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]
In the citing paper
“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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“Obstructive sleep apnea (OSA) is prevalent in 4% of men and 2% of women [4]; among them, up to 93% of women and 82% of men have not been diagnosed [5], resulting in an increased risk of 2–7 folds in causing motor vehicle crashes [6] and causing several chronic diseases, such as metabolic syndrome [7]; neurocognitive d…”
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“OSA affects both sexes, but a two to threefold higher prevalence in men than women [1,25]; the difference might be related to the differences in pharyngeal collapsibility and central respiratory drive [26].”
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“Based on the PSG and clinical findings, 594 patients received a diagnosis of OSA 16,17 ; no patients had prior history of treat-ment for OSA.”
Surgery for obstructive sleep apnoea in adults
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“While individuals with OSA from the general population can be a convenient source of recruitment, they tend to be relatively asymptomatic, raising questions as to the clinical significance of their disease [9, 58].”
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Trazodone increases arousal threshold in obstructive sleep apnoea
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“Its prevalence is higher than 10% [1,2], and it is associated with increased cardiovascular mortality and with all causes of mortality [3–6].”
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“26 Thus it could be argued that primary sleep disorders are a comorbid condition that occur at a similar frequency in CFS/ ME to the general population and are therefore not reflective of the disorder itself.”
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“(11), who reported that among adults aged 30 to 60 years, the prevalence of OSA was 9% for women and 24% for men.”
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“OSA is common in the general population; prevalence estimates from 1993 suggest that OSA afflicts 4% of men and 2% of women (Young et al. 1993).”
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“Moreover, OSA is approximately threefold more prevalent in men as compared with women (8).”
BackgroundA Pilot Trial of a Telecommunications System in Sleep Apnea Management
DeMolles, D. A., Sparrow, D., Gottlieb, D. J., & Friedman, R. (2004) · Medical Care · doi:10.1097/01.mlr.0000132353.99209.fe · Cited by 88
Oral Continuous Positive Airway Pressure for Sleep Apnea
Beecroft, J., Zanon, S., Lukic, D., & Hanly, P. (2003) · Chest · doi:10.1378/chest.124.6.2200 · Cited by 87
Spousal involvement in CPAP adherence among patients with obstructive sleep apnea
Baron, K. G., Smith, T. W., Berg, C. A., Czajkowski, L. A., Gunn, H., & Jones, C. R. (2011) · Sleep And Breathing · doi:10.1007/s11325-010-0374-z · Cited by 88
The effect of sibutramine-assisted weight loss in men with obstructive sleep apnoea
Yee, B. J., Phillips, C. L., Banerjee, D., Caterson, I., Hedner, J. A., & Grunstein, R. R. (2007) · International Journal of Obesity · doi:10.1038/sj.ijo.0803363 · Cited by 87
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Young, T. (2009) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2008.11.003 · Cited by 87
Self-citationSplit-night versus full-night studies for sleep apnoea/hypopnoea syndrome
McArdle, N., Grove, A., Devereux, G., Mackay-Brown, L., Mackay, T., & Douglas, N. J. (2000) · European Respiratory Journal · doi:10.1034/j.1399-3003.2000.15d08.x · Cited by 84
Tangugsorn, V., Krogstad, O., Espeland, L., & Lyberg, T. (2000) · Journal of Cranio-Maxillofacial Surgery · doi:10.1054/jcms.2000.0147 · Cited by 84
Severity of Sleep-Disordered Breathing Improves Following Parturition
Edwards, N., Blyton, D. M., Hennessy, A., & Sullivan, C. E. (2005) · Sleep · doi:10.1093/sleep/28.6.737 · Cited by 84
Lugo, J., Fadeuilhe, C., Gisbert, L., Setien, I., Delgado, M., Corrales, M., Richarte, V., & Ramos-Quiroga, J. A. (2020) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2020.07.004 · Cited by 81
Horner, R. L. (2001) · Respiratory Research · doi:10.1186/rr71 · Cited by 82
The prevalence of obstructive sleep apnea in patients with atrial fibrillation
Abumuamar, A. M., Dorian, P., Newman, D., & Shapiro, C. M. (2018) · Clinical Cardiology · doi:10.1002/clc.22933 · Cited by 83
“Obesity is a well-known risk factor for the development and progression of OSA.(5) Approximately 60% of patients with moderate and severe OSA, and of those referred for a sleep study, are overweight.”
BackgroundSleep Deprivation Worsens Obstructive Sleep Apnea
Persson, H. E., & Svanborg, E. (1996) · Chest · doi:10.1378/chest.109.3.645 · Cited by 79
Du, W., Liu, J., Zhou, J., Ye, D., OuYang, Y., & Deng, Q. (2018) · International Journal of Chronic Obstructive Pulmonary Disease · doi:10.2147/copd.s148735 · Cited by 77
“OSA is estimated to affect 4% of men and 2% of women in the USA, suggesting that ~10 million people in the USA have the disease.(2) OSA is characterized by recurring Correspondence: Qingnan Deng respiratory Diseases group, the 6th Unit, Department of Internal Medicine, guangzhou general hospital of guangzhou Military…”
BackgroundPatel, S. R., Goodloe, R., De, G., Kowgier, M., Weng, J., Buxbaum, S. G., Cade, B., Fulop, T., Gharib, S. A., Gottlieb, D. J., et al. (2012) · PLoS ONE · doi:10.1371/journal.pone.0048836 · Cited by 74
“OSA represents one of the most common sleep disorders with a prevalence of 2 to 4% in children and greater than 10% in adults [14,15].”
BackgroundPathophysiologic and therapeutic implicationsof sleep apnea in congestive heart failure
Bradley, T. D., & Floras, J. S. (1996) · Journal of Cardiac Failure · doi:10.1016/s1071-9164(96)80045-5 · Cited by 78
Aloia, M. S., Arnedt, J. T., Strand, M., Millman, R. P., & Borrelli, B. (2013) · Sleep · doi:10.5665/sleep.3120 · Cited by 78
“Key components of the intervention included: (1) assessing readiness and confidence to change, each on a scale of 1 to 10, and exploring the reasons for choosing that value; (2) discussing what the patient already knows about the effects of sleep apnea and PAP on health, eliciting permission to provide feedback about…”
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Clinical presentations of obstructive sleep apnea syndrome
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Guidelines for sleep studies in adults-a position statement of the Australasian Sleep Association
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“In 1993, the prevalence of moderate to severe OSA (AHI 15 events/hour) in the Wisconsin cohort was 9% for males and 4% for females [11].”
BackgroundRadiofrequency Ablation for the Treatment of Mild to Moderate Obstructive Sleep Apnea
Blumen, M. B., Dahan, S., Fleury, B., Hausser‐Hauw, C., & Chabolle, F. (2002) · The Laryngoscope · doi:10.1097/00005537-200211000-00033 · Cited by 79
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“Obstructive sleep apnea (OSA), which results from upper airway occlusion during sleep, affects at least 4% of men and 2% of women.(1) In addition to excessive daytime somnolence with impairment in cognitive and other functional domains, a substantial body of evidence from large-scale epidemiologic, cross-sectional, an…”
BackgroundKhoo, S. M., Tan, W. C., Ng, T. P., & Ho, C. H. (2004) · Respiratory Medicine · doi:10.1016/j.rmed.2003.11.017 · Cited by 74
Positive Pressure Therapy: A Perspective on Evidence-based Outcomes and Methods of Application
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Guglielmi, O., Lanteri, P., & Garbarino, S. (2019) · Sleep Medicine · doi:10.1016/j.sleep.2019.01.042 · Cited by 71
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Increased Prevalence of Perennial Allergic Rhinitis in Patients with Obstructive Sleep Apnea
Canova, C. R., Downs, S. H., Knoblauch, A., Andersson, M., Tamm, M., & Leuppi, J. D. (2004) · Respiration · doi:10.1159/000076674 · Cited by 74
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“Our findings can be summarized as follows: (1) Waist–hip ratio was the most reliable risk factor for OSA and highly correlated with AHI in both sexes.”
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“Obstructive sleep apnoea (OSA) is a highly prevalent sleep-related breathing disorder affecting up to 30% of middle-aged adults.(1,2)”
BackgroundCardiopulmonary pathology in patients with sleep apnea/obesity hypoventilation syndrome
Ahmed, Q., Chung-Park, M., & Tomashefski, J. F. (1997) · Human Pathology · doi:10.1016/s0046-8177(97)90122-2 · Cited by 73
The joint contribution of insomnia and obstructive sleep apnoea on sickness absence
Sivertsen, B., Björnsdóttir, E., Øverland, S., Bjorvatn, B., & Salo, P. (2013) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2012.01055.x · Cited by 70
“%) is similar to that found in other epidemiological studies based on the general population in similar age cohorts (Bresnitz et al., 1994; Kripke et al., 1997; Ohayon et al., 1997; Partinen, 1995; Young et al., 1993).”
ResultMetabolic impact of shift work
Zimberg, I. Z., Fernandes Junior, S. A., Crispim, C. A., Tufik, S., & de Mello, M. T. (2012) · WORK: A Journal of Prevention, Assessment & Rehabilitation · doi:10.3233/wor-2012-0733-4376 · Cited by 72
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Effects of Menopause and Nasal Occlusion on Breathing During Sleep
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Dort, L., & Brant, R. (2008) · Sleep and Breathing · doi:10.1007/s11325-008-0187-5 · Cited by 68
Metadata
- 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 (medical) › 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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