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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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“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.
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“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]
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“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]
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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.
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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]
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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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“Obesity plays a major role.90”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [90]
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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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“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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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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