Phenotype and Risk Burden of Sleep Apnea: A Population-Based Cohort Study

Sleep apnea (SA) prevalence had increased. The socioeconomic burden is significant because of healthcare-related costs and adverse outcome, especially in moderate-to-severe SA. However, the population impact is unclear, particularly for mild SA. We aimed to assess the current prevalence and the cardiovascular risk associates of SA in the general population. We performed home polygraphy and extensive clinical, sociodemographic, and cardiovascular assessment in 2205 eligible subjects from a population-based cohort. Successful polygraphy was obtained in 1809 subjects (mean age, 56.0; SD, 5.9 years; 52.3% women). The prevalence was 41.0%, 11.8%, and 6.5% for mild, moderate, and severe SA in men and 26.6%, 4.4%, and 1.2% in women. Male sex, age, increasing BMI, and snoring were independently associated with SA, whereas sleepiness or tiredness were not. Compared with those without SA, mild SA was associated with (age- and sex-adjusted OR; 95% CI): diabetes mellitus (2.40; 1.52-3.80), hypertension (1.76; 1.42-2.19), left ventricular hypertrophy (1.36; 1.03-1.79), arterial plaques (1.19; 0.94-1.52), and increased IL-6 (interleukin-6) levels (1.37; 1.10-1.72). These associations were more pronounced in moderate-to-severe SA. To conclude, SA is highly prevalent in the middle-aged general population. It is largely undetected and undetectable using a symptom-based strategy. Yet, even the large group with mild SA shows a manifestly higher metabolic, inflammatory, and cardiovascular risk factor burden, with potential public health implications.