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CC BY-NC-ND 4.0 · Sleep Sci 2022; 15(S 01): 28-40
DOI: 10.5935/1984-0063.20210005
ORIGINAL ARTICLE

The changing profile of obstructive sleep apnea: long term trends in characteristics of patients presenting for diagnostic polysomnography

Ross J. Marriott   ‡
1   Centre for Genetic Origins of Health and Disease, School of Biomedical Sciences, University of Western Australia.
,
Nigel McArdle   ‡
2   School of Anatomy, Physiology and Human Biology, University of Western Australia.
3   West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital.
,
Bhajan Singh
2   School of Anatomy, Physiology and Human Biology, University of Western Australia.
3   West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital.
,
Stuart King
2   School of Anatomy, Physiology and Human Biology, University of Western Australia.
3   West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital.
,
Ivan Ling
3   West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital.
,
Kim Ward
3   West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital.
,
Ellie Darcey
1   Centre for Genetic Origins of Health and Disease, School of Biomedical Sciences, University of Western Australia.
,
Daniela Bond-Smith
1   Centre for Genetic Origins of Health and Disease, School of Biomedical Sciences, University of Western Australia.
,
Sutapa Mukherjee
4   Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, S.A.
5   Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, S.A.
,
Lyle J. Palmer
6   School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
,
David Hillman
2   School of Anatomy, Physiology and Human Biology, University of Western Australia.
3   West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital.
,
Gemma Cadby
1   Centre for Genetic Origins of Health and Disease, School of Biomedical Sciences, University of Western Australia.
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Introduction We aimed to analyze long-term trends in characteristics of patients undergoing diagnostic polysomnography (PSG) and subsequently diagnosed with obstructive sleep apnea (OSA) to inform delivery of sleep services.

Material and Methods We studied 24,510 consecutive patients undergoing PSG at a tertiary-care sleep service between 1989 and 2013. OSA was defined by an apnea hypopnea index (AHI)≥ 5 events/hour. Changes to hypopnea definition and flow sensing techniques in 2002 created two distinct AHI scoring periods: American Sleep Disorders Association (ASDA) 1989 - July 2002 and American Academy of Sleep Medicine (Chicago) from August 2002.

Results Over 23.5 years there was a steady increase in proportion of females (15% to 45%), small increases in average age and BMI, and a small decline in socioeconomic status in the overall group. AHI varied between scoring periods both overall [ASDA 10.8/h (3.2-29.6), Chicago 24.3/h (11.8-48.1)] and in the large subgroup (80.7%) diagnosed with OSA [ASDA 20.7/h (10.6-44.1), Chicago 27.4/h (14.8-51.5)]. OSA diagnosis rates increased in the Chicago period (ASDA 66%, Chicago 91%). Increases in AHI and proportion diagnosed appeared better explained by changes in scoring methods than key OSA risk factors.

Conclusion Temporal increases in proportion of females and decreases in socioeconomic status of people undergoing PSG may reflect greater community awareness of sleep disorders. Temporal increases in age and obesity are consistent with secular trends. Changes in scoring methods have major impacts on OSA diagnosis and judgement of disease severity, with important implications for contemporary resourcing of sleep services and interpretation of historical OSA data.

Polysomnography - Obesity - OSA - Sleep Disorders - BMI - Epidemiology

‡ These authors contributed equally to this work.


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Publication History

Received: 29 October 2020

Accepted: 08 March 2021

Article published online:
01 December 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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