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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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 Proc Am Thorac SocHome page
J. M. Golbin, V. K. Somers, and S. M. Caples
Obstructive Sleep Apnea, Cardiovascular Disease, and Pulmonary Hypertension
Proceedings of the ATS, February 15, 2008; 5(2): 200 - 206.
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 Proc Am Thorac SocHome page
J. C. Lumeng and R. D. Chervin
Epidemiology of Pediatric Obstructive Sleep Apnea
Proceedings of the ATS, February 15, 2008; 5(2): 242 - 252.
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 ChestHome page
E. Tasali, B. Mokhlesi, and E. Van Cauter
Obstructive Sleep Apnea and Type 2 Diabetes*: Interacting Epidemics
Chest, February 1, 2008; 133(2): 496 - 506.
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 J. Appl. Physiol.Home page
J. B. Snow, V. Kitzis, C. E. Norton, S. N. Torres, K. D. Johnson, N. L. Kanagy, B. R. Walker, and T. C. Resta
Differential effects of chronic hypoxia and intermittent hypocapnic and eucapnic hypoxia on pulmonary vasoreactivity
J Appl Physiol, January 1, 2008; 104(1): 110 - 118.
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 Exp Biol MedHome page
C. Selmi, N. Montano, R. Furlan, C. L. Keen, and M. E. Gershwin
Inflammation and Oxidative Stress in Obstructive Sleep Apnea Syndrome
Exp Biol Med, December 1, 2007; 232(11): 1409 - 1413.
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 ChestHome page
N. Kawata, K. Tatsumi, J. Terada, Y. Tada, N. Tanabe, Y. Takiguchi, and T. Kuriyama
Daytime Hypercapnia in Obstructive Sleep Apnea Syndrome
Chest, December 1, 2007; 132(6): 1832 - 1838.
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 Am. J. Respir. Crit. Care Med.Home page
C. F. P. George
Sleep Apnea, Alertness, and Motor Vehicle Crashes
Am. J. Respir. Crit. Care Med., November 15, 2007; 176(10): 954 - 956.
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 ChestHome page
N. P. Patel, M. Ahmed, and I. Rosen
Split-Night Polysomnography
Chest, November 1, 2007; 132(5): 1664 - 1671.
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 ChestHome page
M. Ahmed, N. P. Patel, and I. Rosen
Portable Monitors in the Diagnosis of Obstructive Sleep Apnea
Chest, November 1, 2007; 132(5): 1672 - 1677.
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 PediatricsHome page
E. J. Paavonen, S. Strang-Karlsson, K. Raikkonen, K. Heinonen, A.-K. Pesonen, P. Hovi, S. Andersson, A.-L. Jarvenpaa, J. G. Eriksson, and E. Kajantie
Very Low Birth Weight Increases Risk for Sleep-Disordered Breathing in Young Adulthood: The Helsinki Study of Very Low Birth Weight Adults
Pediatrics, October 1, 2007; 120(4): 778 - 784.
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 Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
G. Parati, C. Lombardi, and K. Narkiewicz
Sleep apnea: epidemiology, pathophysiology, and relation to cardiovascular risk
Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2007; 293(4): R1671 - R1683.
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 Reproductive SciencesHome page
M. L. Okun, M. Hall, and M. E. Coussons-Read
Sleep Disturbances Increase Interleukin-6 Production During Pregnancy: Implications for Pregnancy Complications
Reproductive Sciences, September 1, 2007; 14(6): 560 - 567.
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 Psychosom. Med.Home page
E. M. Friedman, G. D. Love, M. A. Rosenkranz, H. L. Urry, R. J. Davidson, B. H. Singer, and C. D. Ryff
Socioeconomic Status Predicts Objective and Subjective Sleep Quality in Aging Women
Psychosom Med, September 1, 2007; 69(7): 682 - 691.
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 Arch Intern MedHome page
M. A. Arias, A. M. Sanchez, A. Alonso-Fernandez, and F. Garcia-Rio
Atrial Fibrillation, Obesity, and Obstructive Sleep Apnea
Arch Intern Med, July 23, 2007; 167(14): 1552 - 1553.
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 J Am Board Fam MedHome page
M. Alattar, J. J. Harrington, C. M. Mitchell, and P. Sloane
Sleep Problems in Primary Care: A North Carolina Family Practice Research Network (NC-FP-RN) Study
J Am Board Fam Med, July 1, 2007; 20(4): 365 - 374.
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 ChestHome page
S. P. Patil, H. Schneider, A. R. Schwartz, and P. L. Smith
Adult Obstructive Sleep Apnea: Pathophysiology and Diagnosis
Chest, July 1, 2007; 132(1): 325 - 337.
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 Psychosom. Med.Home page
R. D. Wells, K. E. Freedland, R. M. Carney, S. P. Duntley, and E. J. Stepanski
Adherence, Reports of Benefits, and Depression Among Patients Treated With Continuous Positive Airway Pressure
Psychosom Med, June 1, 2007; 69(5): 449 - 454.
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 Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
P. M. de Paula, G. Tolstykh, and S. Mifflin
Chronic intermittent hypoxia alters NMDA and AMPA-evoked currents in NTS neurons receiving carotid body chemoreceptor inputs
Am J Physiol Regulatory Integrative Comp Physiol, June 1, 2007; 292(6): R2259 - R2265.
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 ChestHome page
L. F. Drager, L. A. Bortolotto, A. C. Figueiredo, B. C. Silva, E. M. Krieger, and G. Lorenzi-Filho
Obstructive Sleep Apnea, Hypertension, and Their Interaction on Arterial Stiffness and Heart Remodeling
Chest, May 1, 2007; 131(5): 1379 - 1386.
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 Arch Intern MedHome page
P. Haentjens, A. Van Meerhaeghe, A. Moscariello, S. De Weerdt, K. Poppe, A. Dupont, and B. Velkeniers
The Impact of Continuous Positive Airway Pressure on Blood Pressure in Patients With Obstructive Sleep Apnea Syndrome: Evidence From a Meta-analysis of Placebo-Controlled Randomized Trials
Arch Intern Med, April 23, 2007; 167(8): 757 - 764.
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 J Am Coll CardiolHome page
T. H. Le Jemtel and S. Jelic
Seek and Treat Obstructive Sleep Apnea in Heart Failure
J. Am. Coll. Cardiol., April 17, 2007; 49(15): 1632 - 1633.
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 CirculationHome page
S. Garrigue, J.-L. Pepin, P. Defaye, F. Murgatroyd, Y. Poezevara, J. Clementy, and P. Levy
High Prevalence of Sleep Apnea Syndrome in Patients With Long-Term Pacing: The European Multicenter Polysomnographic Study
Circulation, April 3, 2007; 115(13): 1703 - 1709.
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 Eur Respir JHome page
H. Nakano, T. Tanigawa, T. Furukawa, and S. Nishima
Automatic detection of sleep-disordered breathing from a single-channel airflow record
Eur. Respir. J., April 1, 2007; 29(4): 728 - 736.
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 ChestHome page
S. Ryan, S. Ward, C. Heneghan, and W. T. McNicholas
Predictors of Decreased Spontaneous Baroreflex Sensitivity in Obstructive Sleep Apnea Syndrome
Chest, April 1, 2007; 131(4): 1100 - 1107.
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 Am. J. Respir. Crit. Care Med.Home page
G. E. Foster, P. J. Hanly, M. Ostrowski, and M. J. Poulin
Effects of Continuous Positive Airway Pressure on Cerebral Vascular Response to Hypoxia in Patients with Obstructive Sleep Apnea
Am. J. Respir. Crit. Care Med., April 1, 2007; 175(7): 720 - 725.
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 ThoraxHome page
B. Lam, K. Sam, W. Y. Mok, M. T. Cheung, D. Y. Fong, J. C. Lam, D. C. Lam, L. Y. Yam, and M. S. lp
Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea
Thorax, April 1, 2007; 62(4): 354 - 359.
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