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. 2023 May 15;9(3):00053-2023.
doi: 10.1183/23120541.00053-2023. eCollection 2023 May.

Prevalence, treatment and determinants of obstructive sleep apnoea and its symptoms in a population-based French cohort

Pauline Balagny  1   2   3 , Emmanuelle Vidal-Petiot  1   2   4 , Adeline Renuy  3 , Joane Matta  3 , Justine Frija-Masson  1   2   4 , Philippe Gabriel Steg  1   4   5   6 , Marcel Goldberg  3 , Marie Zins  1   3 , Marie-Pia d'Ortho  1   2   7 , Emmanuel Wiernik  3
Affiliations

Prevalence, treatment and determinants of obstructive sleep apnoea and its symptoms in a population-based French cohort

Pauline Balagny et al. ERJ Open Res. .

Abstract

Background: Obstructive sleep apnoea (OSA) is associated with increased morbidity and mortality. Although the disorder has been well studied in selected high-risk populations, few data exist on its prevalence in the general population. We aimed to assess the prevalence and determinants of OSA in France.

Methods: Data from participants of the French population-based CONSTANCES cohort aged 18-69 years at inclusion and being treated for sleep apnoea or screened for OSA in 2017 using the Berlin Questionnaire were analysed. Weighted analyses were performed to provide recent and representative results in the general population.

Results: Among 20 151 participants, the prevalence of treated sleep apnoea was 3.5% (95% CI 3.0-3.9%). The prevalence of untreated subjects with a positive Berlin Questionnaire was 18.1% (95% CI 17.3-19.2%) for a total weighted prevalence of treated sleep apnoea or high risk of OSA of 20.9% (95% CI 20.0-21.9%). Regarding prevalence of OSA symptoms, it was 37.2% (95% CI 36.1-38.3%) for severe snoring and 14.6% (95% CI 13.8-15.5%) for hypersomnolence. In multivariable logistic regression analysis, male sex, age, previous cardiovascular events, smoking, low educational level, low physical activity and depressive symptoms were associated with having either treated sleep apnoea or a positive Berlin Questionnaire.

Conclusion: In this large French population-based cohort, one in five participants had a high likelihood of OSA, whereas only 3.5% were treated for the disorder, suggesting major underdiagnosis in the general population. OSA diagnosis should be considered more often in people with risk factors such as depressive symptoms as well as unhealthy behaviours and socioeconomic conditions.

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Conflict of interest statement

Conflicts of interest: P. Balagny has received payment for a presentation from ResMed. E. Vidal-Petiot has received honoraria for lectures and support for attending a meeting from Servier. J. Frija-Masson has received research grants from LVL Medical, support for attending meetings from LVL Medical, VitalAire, ADEP assistance and SOS Oxygène, and declares a fiduciary role in Digital Medical Hub SAS. P.G. Steg has received grants from Amarin, AstraZeneca, Bayer, Sanofi and Servier, and consulting fees from Amgen, AstraZeneca, BMS/MyoKardia, Merck, Novo-Nordisk and Regeneron, has sat on steering or critical event committees for Amarin, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Idorsia, Novartis, PhaseBio, Pfizer, Sanofi and Servier, and declares payments for lectures from AstraZeneca, Novartis and Novo-Nordisk, support for attending meetings from AstraZeneca, and participation on a data safety monitoring or advisory board for Servier, Sanofi, PHRI and Monash University. M-P. d'Ortho has received research grants from Sunrise Medical, Desitin, ResMed, Löwenstein and Philips, honoraria for lectures from ResMed, Bioprojet, LVL Medical, VitalAire and Jazz Pharmaceuticals, payment for educational events from Jazz Pharmaceuticals, and support for attending meetings from Bioprojet and Jazz Pharmaceuticals. A. Renuy, J. Matta, M. Goldberg, M. Zins and E. Wiernik declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the study population.
FIGURE 2
FIGURE 2
Associations between each variable and risk of obstructive sleep apnoea. Results are adjusted for age, sex, previous cardiovascular events, household income, educational level, smoking status, alcohol consumption, physical activity, depressive symptoms and marital status. #: reference.
FIGURE 3
FIGURE 3
Results of the items and categories of the Berlin Questionnaire. Weighted percentages (95% CI) refer to the number of participants who checked the items or the combination of items among the 19 543 participants. Any checked item in a framed area yields 1 point except for question 5 that yields 2 points; categories 1 and 2 are considered as positive if their total score is ≥2 points, category 3 is defined as positive if its total score is 1 point (either high blood pressure or obesity). Subjects with in at least two positive categories have a positive Berlin Questionnaire and are considered at high risk for obstructive sleep apnoea.
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