RESUMO
BACKGROUND: There is a scarcity of published data on the global prevalence of obstructive sleep apnoea, a disorder associated with major neurocognitive and cardiovascular sequelae. We used publicly available data and contacted key opinion leaders to estimate the global prevalence of obstructive sleep apnoea. METHODS: We searched PubMed and Embase to identify published studies reporting the prevalence of obstructive sleep apnoea based on objective testing methods. A conversion algorithm was created for studies that did not use the American Academy of Sleep Medicine (AASM) 2012 scoring criteria to identify obstructive sleep apnoea, allowing determination of an equivalent apnoea-hypopnoea index (AHI) for publications that used different criteria. The presence of symptoms was not specifically analysed because of scarce information about symptoms in the reference studies and population data. Prevalence estimates for obstructive sleep apnoea across studies using different diagnostic criteria were standardised with a newly developed algorithm. Countries without obstructive sleep apnoea prevalence data were matched to a similar country with available prevalence data; population similarity was based on the population body-mass index, race, and geographical proximity. The primary outcome was prevalence of obstructive sleep apnoea based on AASM 2012 diagnostic criteria in individuals aged 30-69 years (as this age group generally had available data in the published studies and related to information from the UN for all countries). FINDINGS: Reliable prevalence data for obstructive sleep apnoea were available for 16 countries, from 17 studies. Using AASM 2012 diagnostic criteria and AHI threshold values of five or more events per h and 15 or more events per h, we estimated that 936 million (95% CI 903-970) adults aged 30-69 years (men and women) have mild to severe obstructive sleep apnoea and 425 million (399-450) adults aged 30-69 years have moderate to severe obstructive sleep apnoea globally. The number of affected individuals was highest in China, followed by the USA, Brazil, and India. INTERPRETATION: To our knowledge, this is the first study to report global prevalence of obstructive sleep apnoea; with almost 1 billion people affected, and with prevalence exceeding 50% in some countries, effective diagnostic and treatment strategies are needed to minimise the negative health impacts and to maximise cost-effectiveness. FUNDING: ResMed.
Assuntos
Efeitos Psicossociais da Doença , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Ásia/epidemiologia , Australásia/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Prevalência , América do Sul/epidemiologia , Estados Unidos/epidemiologiaRESUMO
Study Objectives: To examine the bidirectional association between physical activity (PA) and polysomnographically (PSG)-assessed sleep parameters characterized by total sleep time (TST), sleep onset latency (SOL), wake time after sleep onset (WASO), sleep efficiency and percentage of TST in N1, N2, and N3 stages and rapid eye movement (REM) sleep in middle-aged and older adults. Methods: Longitudinal study based on a subsample of the Wisconsin Sleep Cohort. Self-reported PA information was used to estimate the metabolic equivalents of task (MET-minutes/week) activity and in-laboratory PSG exams provided information on sleep parameters at baseline and after 3-11 years of follow-up between 2004 and 2015. Poisson and linear regression models controlling for confounders estimated associations of sleep outcomes with changes in PA. Results: A total of 424 participants (45.8% female; mean ± SD age 60.1 ± 7.5 years) were followed over an average of 5.0 ± 1.6 years. Compared to baseline PA of <500 MET-minutes/week (reference category), 500 to 1500 MET-minutes/week of PA was associated with lower incidences of TST <6 hours (relative risk, RR: 0.49; 95% confidence interval, CI: 0.27; 0.88), WASO >60 minutes (RR: 0.58; 95% CI: 0.41; 0.82) and sleep efficiency <80% (RR: 0.61; 95% CI: 0.39; 0.94), adjusting for sociodemographic, health behaviors and medical conditions. No significant associations were observed between baseline sleep characteristics and changes in PA through the follow-up. Conclusion: In this prospective study, an intermediate level of PA at baseline predicted lower risk of incident short sleep time, higher WASO and lower sleep efficiency measured with PSG.