Sleep Apnea Facts and Figures by ResMed

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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 apnea6,12
  • 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

 

For more information get in touch with:

PT ResIndo Medika

Graha BIP, 5th Floor

Jl. Jend. Gatot Subroto Kav. 23

Jakarta 12930

Indonesia

Phone: +62-21 525 8230-31

Fax   :  +62-21 252 1380

Mobile: +62-856 802 8888

            +62-812 8853 1052

 

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
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