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American Journal of Respiratory and Critical Care Medicine Vol 165. pp. 1217-1239, (2002)
© 2002 American Thoracic Society

State of the Art

Epidemiology of Obstructive Sleep Apnea

A Population Health Perspective

Terry Young, Paul E. Peppard and Daniel J. Gottlieb

Department of Population Health Sciences, University of Wisconsin—Madison, Madison, Wisconsin; and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts

Correspondence and requests for reprints should be addressed to Terry Young, Ph.D., Department of Population Health Sciences, University of Wisconsin—Madison, 502 N. Walnut Street, Madison, WI 53705. E-mail: tbyoung{at}facstaff.wisc.edu

Population-based epidemiologic studies have uncovered the high prevalence and wide severity spectrum of undiagnosed obstructive sleep apnea, and have consistently found that even mild obstructive sleep apnea is associated with significant morbidity. Evidence from methodologically strong cohort studies indicates that undiagnosed obstructive sleep apnea, with or without symptoms, is independently associated with increased likelihood of hypertension, cardiovascular disease, stroke, daytime sleepiness, motor vehicle accidents, and diminished quality of life. Strategies to decrease the high prevalence and associated morbidity of obstructive sleep apnea are critically needed. The reduction or elimination of risk factors through public health initiatives with clinical support holds promise. Potentially modifiable risk factors considered in this review include overweight and obesity, alcohol, smoking, nasal congestion, and estrogen depletion in menopause. Data suggest that obstructive sleep apnea is associated with all these factors, but at present the only intervention strategy supported with adequate evidence is weight loss. A focus on weight control is especially important given the expanding epidemic of overweight and obesity in the United States. Primary care providers will be central to clinical approaches for addressing the burden and the development of cost-effective case-finding strategies and feasible treatment for mild obstructive sleep apnea warrants high priority.

Key Words: obstructive sleep apnea • sleep-disordered breathing • epidemiology • sleep disorder




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