Which Country Has the Highest Incidence of Sleep Apnea?

Obstructive sleep apnea (OSA), known simply as sleep apnea, is a highly prevalent sleep disorder. It is characterized by repeated pauses in breathing during sleep, which can last anywhere from 10 seconds to over a minute [1]. These episodes lead to chronically fragmented sleep and increase your risk of high blood pressure, heart disease, stroke, diabetes, and even early death [2]. 

But how common is sleep apnea exactly, and which country is most affected? Well, research carried out by ResMed has found some surprising numbers when it comes to the global burden of sleep apnea. According to their findings, not all parts of the world are affected equally. Find out which country has the highest rate of this common sleep problem below. 

Sleep Apnea by the Numbers

Sleep experts and researchers have known for a long time that sleep apnea is fairly common. But until a couple of years ago, estimating its prevalence in the general population was a guessing game. This is due to a lack of statistical analyses and because the majority of sleep apnea cases remain undiagnosed [3]. 

But a 2019 study by  ResMed, which was presented by the American Academy of Sleep Medicine (AASM) and the Sleep Research Society, is the first to give us close estimates [4].

Three major findings from this study are:

1. Almost a billion people ages 30 to 69 have sleep apnea. Previous estimates suggested that about 100 million people were affected — which was a serious understatement [5].

1. Less than half of those affected (425 million) have severe sleep apnea, defined as an apnea-hypopnea index (AHI) of 15 apnea events per hour. 

1. Obstructive sleep apnoea is likely less common in adults younger than 30 years and more often found in adults aged 70 years and older. 

What About Sleep Apnea Prevalence By Country?

The same study also looked at the available data to determine sleep apnea prevalence by country. The researchers searched PubMed and Embase to find studies reporting sleep apnea prevalence and used a conversion algorithm for countries outside the United States. The results were as follows: 

• The country with the highest number of sleep apnea sufferers was China at 66 million people or 8.8% of the entire population.

• China was followed by the United States, Brazil, and India as far as numbers go. 

• Based on AASM criteria from 2012, the researchers estimated that 170 million adults, or almost 40% of the population in the Americas may suffer from OSA.

• The prevalence of OSA also ranged from 7.8% in Hong Kong to 77.2% in Malaysia for mild apnea. 

• Severe apnea was less common in Ireland and Israel, with an estimated 4.8% of the population having this sleep disorder, and most common in Switzerland at 36.6%.

Why Is Sleep Apnea so Common, and What to Do About It?

The rising global prevalence of sleep apnea is due to more people being overweight and older than in decades past, according to the researchers carrying out this study. Obesity rates have doubled over the past four decades [6]. And according to the World Health Organization, 1 in 6 people will be over 60 years by 2030 [7]. 

Both older age and obesity are the leading risk factors for OSA, explaining its growing prevalence. What this also means is that more people are at risk of its sequelae, such as heart disease and type 2 diabetes.

But sleep apnea is preventable and treatable. Losing weight, following a balanced diet, and exercising regularly can lower your risk of many chronic diseases, sleep apnea included. If you suspect you may have the disease, seeing a sleep specialist is the first step toward treatment, which may include conservative measures, continuous positive airway pressure (CPAP) therapy, ororal appliance therapy. 

References:

1. Wu H, Zhan X, Zhao M, Wei Y. Mean apnea-hypopnea duration (but not apnea-hypopnea index) is associated with worse hypertension in patients with obstructive sleep apnea.Medicine (Baltimore). 2016;95(48):e5493.doi:10.1097/MD.0000000000005493

1. Learn About Sleep Apnea. American Lung Association. Last updated: November 17, 2022.https://www.lung.org/lung-health-diseases/lung-disease-lookup/sleep-apnea/learn-about-sleep-apnea#:~:text=There%20are%20serious%20potential%20consequences,and%20result%20in%20early%20death.

1. Finkel KJ, Searleman AC, Tymkew H, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center.Sleep Med. 2009;10(7):753-758.doi:10.1016/j.sleep.2008.08.007

1. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis.Lancet Respir Med. 2019;7(8):687-698.doi:10.1016/S2213-2600(19)30198-5

1. New Analysis Shows Sleep Apnea More Common in Americas than Previously Thought. ResMed. June 2019.https://investors.resmed.com/investor-relations/events-and-presentations/press-releases/press-release-details/2019/New-Analysis-Shows-Sleep-Apnea-More-Common-in-Americas-than-Previously-Thought/default.aspx#:~:text=3%20countries%20with%20the%20highest,and%20Colombia%20(11%20million).

1. GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years.N Engl J Med. 2017;377(1):13-27.doi:10.1056/NEJMoa1614362

1. Ageing and health. World Health Organization. 1 October 2022.https://www.who.int/news-room/fact-sheets/detail/ageing-and-health#:~:text=By%202030%2C%201%20in%206,will%20double%20(2.1%20billion).