Prevalence
The prevalence of OSA in middle aged and older people is high but does not always produce symptoms or require treatment.
OSA, defined as an apnoea hypopnea index > 15 events per hour on a sleep study, affects ~20% of the population, while simple snoring which is highly prevalent affects 30% of the adult population (See Presentation & Risk Factors)1, 2 The prevalence of obstructive sleep apnoea syndrome (OSAS) - defined as AHI ≥ 5 events per hour combined with symptoms e.g. excessive daytime sleepiness (International Classification of Sleep Disorders (ICSD-3) criteria) - affects 2-5% of the general middle-aged population. The Australian MAILES study reported that 14% of men had moderate-severe OSA while 2% of men had OSA and excessive daytime sleepiness.3
Of Note, the prevalence of OSA in the general population, especially in older adults (ages 65-79 years), based on the standard criteria of an apnoea-hypopnoea index (AHI) cut-off of ≥ 5, is very high. Therefore the a priori chance of a positive diagnosis of OSA is high. OSA per definition does not compel medical treatment as a large proportion of people with OSA, based on AHI ≥ 5 are asymptomatic. As such, people with OSAS, i.e. AHI > 15 or > 30 when aged 65 years old or more, with daytime sleepiness symptoms and/or cardiometabolic comorbidities and/or impact of OSA on their quality of life, will likely benefit most from medical treatment.
OSA costs the Australian community an estimated $26 billion annually including direct health costs, cardiovascular complications and loss of productivity.4
AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset