Sleep Apnea Facts and Figures by ResMed

What is sleep-disordered breathing (SDB)?

SDB describes a number of nocturnal breathing disorders:

• Obstructive sleep apnea (OSA)
• Central sleep apnea (CSA)
• Nocturnal hypoventilation
• Cheyne–Stokes respiration (CSR)

What is obstructive sleep apnea (OSA)?

• The most common form of SDB
• A partial or complete collapse of the upper airway caused by relaxation of the muscles controlling the soft palate and tongue
• Person experiences apneas, hypopneas and flow limitation
• Apnea: a cessation of airflow for more than ten seconds
• Hypopnea: a decrease in airflow lasting more than ten seconds with a 30 percent reduction in airflow and at least a three percent oxygen desaturation from the baseline
• Flow limitation: narrowing of the upper airway and an indication of an impending upper airway closure

Signs and symptoms of sleep apnea?

• Lack of energy
• Morning headaches
• Frequent nocturnal urination
• Depression
• Excessive daytime sleepiness (EDS)
• Nighttime gasping, choking or coughing
• Gastroesophageal reflux (GE reflux)
• Irregular breathing during sleep (e.g., snoring)

Classification of sleep apnea

Apnea–hypopnea index (AHI)

• Number of apneas and/or hypopneas per hour of sleep (or study time)
• Reflects the severity of sleep apnea

AHI: less than five                             Normal range

AHI: five  to less than 15                   Mild sleep apnea

AHI: 15 to less than 30                      Moderate sleep apnea

AHI: 30                    Severe sleep apnea

Prevalence of sleep apnea

• Approximately 42 million American adults have SDB¹
• An estimated 26 percent of adults have at least mild SDB²
• Nine percent of middle-aged women and 25 percent of middle-aged men suffer from OSA³
• Prevalence in the US is similar to asthma (20 million) and diabetes (23.6 million)⁴
• 75 percent of severe SDB cases remain undiagnosed⁵

Increased risk factors for sleep apnea

• Obesity (BMI >30)
• Diagnosis of hypertension
• Large neck circumference (>17” men; >16” women)
• Male gender
• Excessive use of alcohol or sedatives
• Upper airway or facial abnormalities
• Smoking
• Family history of OSA
• Endocrine and metabolic disorders

Cardiovascular links

• 1 million people in the US have heart failure¹⁴
• Approximately 76 percent of congestive heart failure patients have SDB8
• Heart failure is the most expensive disorder to treat¹⁵
• OSA noted in 49 percent of atrial fibrillation patients¹⁰ and 30 percent of cardiovascular patients¹³
• OSA presents in 70 percent of heart attack patients with AHI greater than five and 52 percent of heart attack patients with AHI greater than ten¹⁶

Hypertension links

• Studies have shown that sleep apnea is an independent risk factor for hypertension
• 30–83 percent of patients with hypertension have sleep apnea^6,12
• 43 percent of patients with mild OSA and 69 percent of patients with severe OSA have hypertension⁵
• AHA guidelines on drug-resistant hypertension have shown that treatment of sleep apnea with CPAP is likely to improve blood pressure control

Type 2 diabetes links

• 48 percent of type two diabetes sufferers have sleep apnea¹¹
• OSA may have a causal role in the development of type two diabetes¹⁷
• OSA is associated with insulin resistance (independent of obesity)¹⁸
• 30 percent of patients presented to a sleep clinic have impaired glucose intolerance¹⁹
• Mild forms of SDB may be important in predicting risk of pre-diabetes²⁰
• 86 percent of obese type two diabetic patients suffer from sleep apnea²¹

Stroke risk

• 65 percent of stroke patients have SDB²²
• Moderate to severe sleep apnea triples stroke risk in men²³

Mortality links

• SDB is associated with a threefold increase in mortality risk⁵
• There is an independent association of moderate to severe OSA with increased mortality risk³
• Severe sleep apnea raises death risk by 46 percent²⁴

Health care costs (Economic consequences of untreated SDB)

• Patients with untreated OSA had 82 percent higher in-patient hospital costs than treated patients²⁵
• Patients with OSA have higher utilisation rates and incur greater costs than non-OSA patients for up to ten years prior to diagnosis²⁶
• OSA patients on PAP therapy have 31 percent lower total medical costs than patients not on PAP therapy²⁵

Traffic accidents

• In the year 2000, 810,000 US drivers were involved in a motor vehicle accident related to OSA – 1,400 involved fatalities²⁷
• Treating all US drivers suffering from sleep apnea would save US$11.1 billion in collision costs and saves 980 lives annually²⁷

Treatment of OSA with CPAP

• CPAP treatment reduces the need for acute hospital admission due to cardiovascular disease in patients with sleep apnea²⁸
• CPAP reduces blood glucose levels²⁹
• Two nights of CPAP improves insulin sensitivity, sustained at the three-month interval³⁰
• For every dollar spent on CPAP, US$3.49 would be saved in reduced collision costs²⁷

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References:

• Young et al. New Engl J Med 1993
• Peppard et al. J Am Med Assoc 2013
• Marshall et al. Sleep 2008
• US Department of Health and Human Services, Centers for Disease Control and Prevention 2008
• Young et al. Sleep 2008
• Logan et al. J Hypertens 2001
• O’Keeffe & Patterson. Obes Surg 2004
• Oldenburg et al. Eur J Heart Fail 2007
• Garrigue et al. Circulation 2007
• Gami et al. Circulation 2004
• Einhorn et al. Endocr Pract 2007
• Sjostrom et al. Thorax 2002
• Schafer et al. Cardiology 1999
• Go AS, et al. American Heart Association 2013
• Medicare – $20.4 billion p.a.
• Kuniyoshi et al. J Am Coll Cardiol 2008
• 17 Reichmuth et al. Am J Respir Crit Care Med 2005
• 18 Punjabi et al. Am J Respir Crit Care Med 2002
• Meslier et al. Eur Respir J 2003
• Stamatakis et al. Sleep 2008
• Foster et al. Diabetes Care 2009
• Dyken et al. Stroke 1996
• Redline et al. Am J Respir Crit Care Med 2010
• Punjabi et al. PLoS Medicine 2009
• Potts et al. Popul Health Manag 2012
• Albarrak et al. Sleep 2005
• Sassani et al. Sleep 2004
• Peker et al. Am J Respir Crit Care Med 1997
• Babu et al. Arch Intern Med 2005
• Harsch et al. Am J Respir Crit Care Med 2004