Prevalence of Sleep-Disordered Breathing On The Rise.
June 1, 2016
A study estimates SDB prevalence rates that are substantially higher than rates 2 decades ago, in part due to rising obesity.
BY PETER BLAIS, RPSGT
Sleep-disordered breathing (SDB) is very common—especially in middle-aged and older adults—and is associated with a wide range of negative outcomes. These outcomes include cardiovascular disease, depressed mood, cognitive deficits, accidents, and injury (among others), according to one of the authors of a recent study published in the American Journal of Epidemiology.
“Over the last two decades, SDB has become increasingly prevalent, to the point that clinicians that see several adult patients daily are likely to come in contact with persons with undiagnosed SDB on a regular basis,” says study author Paul Peppard, PhD, who is a University of Wisconsin School of Medicine and Public Health researcher.
The study provides up-to-date estimates of US rates of SDB prevalence by age, sex, and BMI strata and suggests that prevalence rates in middle-aged adults have risen substantially in recent decades.
The study estimates that about 13% of men and 6% of women between 30 and 70 years old have moderate to severe SDB (AHI ≥15). It also estimates 14% of men and 5% of women have an AHI ≥5 (cutoff figure for mild SDB) plus symptoms of daytime sleepiness. Either of these SDB definitions fit the Medicare criteria for a positive indication of obstructive sleep apnea.
These prevalence estimates represent double-digit relative percentage increases, ranging from approximately 14% up to 55% (depending on age group, sex, and SDB severity level). “The estimated increases translate to millions of additional afflicted persons in the United States, and, consequently, incidences of sequelae of SDB, such as cardiovascular morbidities and stroke, cognitive decline, depression and premature death are likely accelerated relative to levels that would otherwise be expected,” the study states.
The results can be used to estimate future SDB prevalence if there are further alterations in population distributions of overweight and obesity. “This information is essential for the clinical and public health sectors because of the growing high population burden of SDB, the treatability of SDB, and the myriad negative health consequences of untreated SDB,” the study states.
Obesity is a strong causal factor for SDB, and because of the ongoing obesity epidemic, previous estimates of SDB prevalence require updating. The study estimates SDB rates in the United States for the periods of 1988-1994 and 2007–2010 from an employed population of 1,520 Wisconsin adults. SDB prevalence was modeled as a function of age, sex, and BMI, and estimates extrapolated to US body mass index distributions estimated using data from the National Health and Nutrition Examination Survey.
“The most important modifiable causes of SDB in adult populations are overweight and obesity,” reads the study. “Over the last few decades, the prevalence rates of overweight and obesity experienced epidemic trajectories in the United States, which is likely to have resulted in increased occurrence of obesity-related outcomes, including SDB.”
Peppard says he does not feel qualified to speak to what all dentists should do as part of their practices regarding SDB screening, but he notes that most people with SDB are undiagnosed.
