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High prevalence of undiagnosed obstructive sleep apnoea in the general population and methods for screening for representative controls

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Abstract

Purpose

Undiagnosed obstructive sleep apnoea (OSA) in the community makes comparisons of OSA subjects with control samples from the general population problematic. This study aims to estimate undiagnosed moderate to severe OSA in a general population sample and to determine the capacity of questions from the Berlin questionnaire (BQ) to identify subjects without diagnosed OSA of this severity.

Methods

Using a general population sample (n = 793) with no history of OSA, case and control status for moderate–severe OSA was determined by home-based nasal flow and oximetry-derived apnoea–hypopnoea index using a cut-off value of ≥15 events/h to define cases. The diagnostic accuracy of the complete BQ and its component questions in identifying cases was assessed by calculating sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and post-test probabilities.

Results

The age-standardised prevalence estimate of moderate–severe OSA was 9.1 % (12.4 % in men, 5.7 % in women). Sensitivity of the BQ in this population was 54 %, and specificity, 70 %. A combination of questions regarding snoring frequency and hypertension provided maximal post-test probability of OSA and greatest post-screen sample size.

Conclusions

Undiagnosed OSA is highly prevalent in the Western Australian general population. While the complete BQ is a sub-optimal screening instrument for the general population, snoring frequency or hypertension can be used to screen out moderate–severe OSA from general population samples with limited reduction in sample size. As there are few general population samples available for epidemiological or genetic studies of OSA and its associated phenotypes, these results may usefully inform future case–control studies.

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Acknowledgments

The authors gratefully acknowledge Michelle Olaithe, Matthew Knuiman, Kashif Mukhtar and Mark Divitini, the Busselton community and the ResMed Science Center.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Centre for Genetic Epidemiology and Biostatistics, University of Western Australia, 14-16 Parkway, Crawley, Perth, 6009, WA, Australia

    Laila Simpson & Kim L. Ward

  2. School of Anatomy and Human Biology, Faculty of Life and Physical Sciences, The University of Western Australia, Perth, WA, Australia

    Laila Simpson & Peter Eastwood

  3. Western Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia

    Laila Simpson, David R. Hillman, Kim L. Ward, Stewart Cullen, Alan James, Sutapa Mukherjee & Peter Eastwood

  4. Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, WA, Australia

    David R. Hillman, Kim L. Ward, Stewart Cullen, Alan James & Peter Eastwood

  5. Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia

    Matthew N. Cooper

  6. School of Population Health, University of Western Australia, Perth, WA, Australia

    Kim L. Ward & Michael Hunter

  7. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Sutapa Mukherjee

  8. Women’s College Research Institute/Women’s College Hospital, Toronto, ON, Canada

    Sutapa Mukherjee

  9. Busselton Population Medical Research Institute, University of Western Australia, Perth, WA, Australia

    Michael Hunter & Alan James

  10. Genetic Epidemiology and Biostatistics Platform, Ontario Institute for Cancer Research, Toronto, ON, Canada

    Lyle J. Palmer

  11. Samuel Lunenfeld Research Institute, University of Toronto, Toronto, ON, Canada

    Lyle J. Palmer

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  1. Laila Simpson
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  2. David R. Hillman
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  3. Matthew N. Cooper
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  4. Kim L. Ward
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  5. Michael Hunter
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  7. Alan James
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  8. Lyle J. Palmer
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  9. Sutapa Mukherjee
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  10. Peter Eastwood
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Correspondence to Laila Simpson.

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Simpson, L., Hillman, D.R., Cooper, M.N. et al. High prevalence of undiagnosed obstructive sleep apnoea in the general population and methods for screening for representative controls. Sleep Breath 17, 967–973 (2013). https://doi.org/10.1007/s11325-012-0785-0

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  • DOI: https://doi.org/10.1007/s11325-012-0785-0

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