Prevalence and risk factors of obstructive sleep apnea among middle-aged urban Indians: A community-based study

doi:10.1016/j.sleep.2008.08.011

Sleep Medicine

Volume 10, Issue 8, September 2009, Pages 913-918

https://doi.org/10.1016/j.sleep.2008.08.011 Get rights and content

Abstract

Background

The epidemiology of obstructive sleep apnea (OSA) and obstructive sleep apnea syndrome (OSAS) is not well studied among Indians. We sought to determine the prevalence and risk factors of OSA in a middle-aged urban Indian population.

Methods

We conducted a two-stage, cross-sectional, community-based study in four different socioeconomic zones of the South Delhi district, India, from April 2005 to June 2007. In stage 1, subjects of either gender aged 30–65 yrs were administered a questionnaire by door-to-door survey using systematic random sampling. Subjects that responded were classified as habitual and non-habitual snorers. In stage 2, all the habitual and 10% of randomly selected non-habitual snorers were invited for overnight polysomnographic study.

Results

Of the 2860 subjects approached, 2505 (88%) completed stage 1. Habitual snoring was present in 452 (18%) subjects. In stage 2, OSA defined as apnea–hypopnea index ⩾5 was observed in 94 (32.4%) of 290 habitual snorers and 3 (4%) of 75 non-habitual snorers. Estimated population prevalence of OSA and OSAS was 9.3% (95% CI 8.2–10.5%) and 2.8% (2.1–3.4%) respectively. On multivariable analysis, male gender (adjusted odds ratio 3.8 [1.7–4.9]), body-mass index ⩾25 kg/m² (4.1 [2.0–8.3]), and abdominal obesity (2.2 [1.9–5.3]) were independently associated with the presence of OSA. A linear trend was observed in the prevalence of OSA across the socioeconomic strata.

Conclusions

OSA is a significant public health problem in the middle-aged Indian population across the socioeconomic spectrum. OSA is associated with some of the well known risk factors for cardiovascular disease.

Introduction

Obstructive sleep apnea syndrome (OSAS) is a potentially disabling condition characterized by disruptive snoring, repeated episodes of complete or partial pharyngeal obstruction during sleep resulting in nocturnal hypoxemia, frequent arousals during sleep, and excessive daytime sleepiness. Undiagnosed OSAS represents a major public health problem. It is receiving increased attention because of convincing data showing its association with adverse cardiovascular, neurocognitive, and metabolic consequences [1], [2], [3]. Sleep fragmentation leads to impaired neurocognitive function, poor quality of life, and predisposes to motor vehicle and workplace accidents. Notwithstanding, the condition remains mostly undiagnosed.

Several population-based studies have found the prevalence of OSAS to be 0.3–5.1% [4], [5], [6], [7], [8]. These estimates, however, are based on data from predominantly white populations and may not be applicable to others. Indians are prone to develop obesity and its consequences [9]. Increased urban migration and economic growth have led to an epidemic of lifestyle-related health problems among Indians [10]. Data regarding the prevalence of OSA in Asians, particularly the Indian population, are sparse [11], [12], [13], [14]. Earlier, we studied the prevalence of OSA in a semi-urban Indian population; however, it was a small-sized study, and different socioeconomic strata were not adequately represented in the study population [14]. In the present study, we sought to determine the prevalence of OSA and the risk factors associated with it across the spectrum of socioeconomic classes in an urban Indian population.

Section snippets

Study design

Two-stage, cross-sectional, community-based study.

Study population

The national capital territory of Delhi has a population of 13.8 million spread over an area of 1483 km². Of the nine administrative districts of Delhi, South Delhi is the second most populous, having a population of 2.26 million. This study was conducted in four zones of the South Delhi district. Each of these zones is relatively homogeneous with respect to the socioeconomic class of people living in that zone, with Okhla industrial area (Sanjay

Results

Over a period of 23 months, 2860 subjects were surveyed, of which 2505 (88%) responded. A flow diagram depicting the number of subjects recruited at each step is shown in Fig. 1. The response rate in stage 1 was comparable among the four different socioeconomic zones (Okhla – 656/781 [84%], Ambedkar Nagar – 646/673 [96%], Netaji Nagar – 603/663 [91%], and Gautam Nagar – 600/682 [88%]).

Discussion

We found the prevalence of OSA in a middle-aged urban Indian population to be 9.3% and that of OSAS to be 2.8%. Ours is the first community-based prevalence study in the Indian subcontinent to cover such a wide socioeconomic base that faithfully characterizes the urban communities in India. Our sample population was selected in such a manner that all socioeconomic groups were adequately represented. We employed a two-stage probability sampling method, thus minimizing the chance of selection

Conflict of interest

We declare that we have no conflict of interest.

Funding

Supported by an unrestricted educational grant from Pfizer India Ltd. to SKS.

Acknowledgments

We thank Dr. Kalaivani for her help in statistical analyses; sleep technicians Mr. Hridesh Mishra, Mr. Jitender Sharma, and Mr. Jitender Kumar; field workers Mr. Balram, Mr. Kuldeep, and Mr. Santosh for their assistance in data collection. TK is supported by the Scientists’ Pool Scheme of the Council of Scientific and Industrial Research, Government of India. We are grateful to the anonymous reviewer for his/her invaluable suggestions.

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Citation Excerpt :
According to AHI, OSA is graded into 3 severity groups: mild OSA (5 ≤ AHI < 15 events/h), moderate OSA (15 ≤ AHI < 30 events/h), and severe OSA (AHI ≥ 30 events/h).7 OSA has become a health problem of global concern, estimated to affect approximately 13-33% of males and 6-19% of females.8,9 Hypoxia and hypercapnia caused by OSA are closely associated with endothelial dysfunction and heart remodeling and would eventually boost the risk of cardiovascular events.10
This study aims to analyze the association of obstructive sleep apnea (OSA) with endothelial function and heart structure in patients with hypertension and lay a clinical foundation for preventing and treating endothelial dysfunction and heart remodeling in patients with hypertension.
A cross-sectional study design was adopted in this study. From April 2020 to April 2021, 143 patients with hypertension were included and classified into two groups according to the severity of OSA: 81 patients with hypertension without OSA [apnea-hypopnea index (AHI) < 5 events/hour] serving as the control group; 62 patients with hypertension with moderate-severe OSA (AHI ≥ 15 events/hour) serving as the OSA group. The endothelial function and heart structure were assessed by flow‐mediated vasodilation (FMD) and transthoracic echocardiography. Logistic regression analyses were conducted to identify factors associated with endothelial dysfunction and heart remodeling.
Compared with the control group, patients with OSA had significantly greater interventricular septal thickness (IVST) and left ventricular posterior wall thickness (LVPWT) (P < 0.05), and FMD exhibited a significant decrease (P < 0.05). Logistic regression analyses demonstrated that gender and AHI were associated with FMD (P < 0.05), and FMD was associated with LVMI (P < 0.05).
OSA was associated with endothelial dysfunction and heart remodeling in patients with hypertension. Endothelial dysfunction may be crucial for the development of heart remodeling in patients with hypertension with OSA.
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The study aimed to evaluate the prevalence of mental illness in obstructive sleep apnea (OSA) and to examine whether patients with obstructive sleep apnea require screening for mental illness.
We performed polysomnography studies of patients that were referred from various subspecialty clinics in Kashmir from Jan 2020–December 2020. using the Mini-International Neuropsychiatric Interview (MINI plus) scale to make a psychiatric diagnosis. We administered the General Health Questionnaire – 28 (GHQ – 28), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) to patients. Descriptive statistics and correlations were used for data analysis.
182 patients underwent polysomnography, 85 (46.7%) of which were suffering from mental illness Based on the Apnea-Hypopnea Index score, 8 (4.39%) patients had mild, 35 (41.1%) had moderate and 42 (49.4%) had severe OSA. The mean GHQ -28 score was significantly higher in patients with Obstructive sleep apnea (p < 0.001) (11.34 ± 8.2) as compared to non-Obstructive sleep apnea patients (1.98 ± 4.38).
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Original ArticlePrevalence and risk factors of obstructive sleep apnea among middle-aged urban Indians: A community-based study

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Study design

Study population

Results

Discussion

Conflict of interest

Funding

Acknowledgments

Diabetes Res Clin Pract

Chest

Chest

Sleep Med

Prospective study of the association between sleep disordered breathing and hypertension

N Engl J Med

Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study

Am J Respir Crit Care Med

Obstructive sleep apnea is independently associated with an increased prevalence of metabolic syndrome

Eur Heart J

The occurrence of sleep-disordered breathing among middle-aged adults

N Engl J Med

Snoring and sleep apnea: a population study in Australian men

Am J Respir Crit Care Med

Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle-aged men

Thorax

Prevalence of sleep-disordered breathing in women: effects of gender

Am J Respir Crit Care Med

Sleep disordered breathing in community-dwelling elderly

Sleep

Serial epidemiological surveys in an urban Indian population demonstrate increasing coronary risk factors among the lower socioeconomic strata

J Assoc Physicians India

Original Article
Prevalence and risk factors of obstructive sleep apnea among middle-aged urban Indians: A community-based study