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. 2025 Jun 16;16(1):5100.
doi: 10.1038/s41467-025-60218-1.

Global warming may increase the burden of obstructive sleep apnea

Bastien Lechat  1 , Jack Manners  2 , Lucía Pinilla  2 , Amy C Reynolds  2 , Hannah Scott  2 , Daniel Vena  3 , Sebastien Bailly  4 , Josh Fitton  2 , Barbara Toson  2 , Billingsley Kaambwa  5 , Robert J Adams  2 , Jean-Louis Pepin  4 , Pierre Escourrou  6 , Peter Catcheside  2 , Danny J Eckert  2
Affiliations

Global warming may increase the burden of obstructive sleep apnea

Bastien Lechat et al. Nat Commun. .

Abstract

High ambient temperatures are associated with reduced sleep duration and quality, but effects on obstructive sleep apnea (OSA) severity are unknown. Here we quantify the effect of 24 h ambient temperature on nightly OSA severity in 116,620 users of a Food and Drug Administration-cleared nearable over 3.5 years. Wellbeing and productivity OSA burden for different levels of global warming were estimated. Globally, higher temperatures (99th vs. 25th; 27.3 vs. 6.4 °C) were associated with a 45% higher probability of having OSA on a given night (mean [95% confidence interval]; 1.45 [1.44, 1.47]). Warming-related increase in OSA prevalence in 2023 was estimated to be associated with a loss of 788,198 (489,226, 1,087,170) healthy life years (in 29 countries), and a workplace productivity loss of 30 (21 to 40) billion United States dollars. Scenarios with projected temperatures ≥1.8 °C above pre-industrial levels would incur a further 1.2 to 3-fold increase in OSA burden by 2100.

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Conflict of interest statement

Competing interests: P.E. serves as a consultant for Withings. Outside the submitted work, B.L. has had research grants from Withings, Medical Research Future Fund and NHMRC. Outside the submitted work, D.J.E. has had research grants from Bayer, Apnimed, Takeda, Invicta Medical, Eli Lilly and Withings. D.J.E. currently serves as a scientific advisor/consultant for Apnimed, Invicta Medical, Takeda, SleepRes and Mosanna. A.C.R. has received research funding from the Lifetime Support Authority, Sleep Health Foundation, Flinders Foundation, Medical Research Future Fund, NHMRC, the Hospital Research Foundation, Compumedics, and Sydney Trains, and speaker and consultancy fees from Teva Pharmaceuticals, Sealy Australia, and the Sleep Health Foundation for work unrelated to this study. H.S. reports consultancy and/or research support from Re-Time Pty Ltd, Compumedics Ltd, the American Academy of Sleep Medicine Foundation, and Flinders University. R.J.A. reports research support from the NHMRC, Flinders Foundation, the Hospital Research Foundation, Big Health, Philips Respironics, ResMed Foundation, Flinders University, Sydney Trains and, and speaker and consultancy fees from SomnoMed. P.C. reports grants from NHMRC, Medical Research Future Fund, Flinders Foundation, Invicta Medical, Garnett Passe and Rodney Williams Memorial Foundation, Defence Science and Technology Group. None of the other authors have any potential conflicts to declare.

Figures

Fig. 1
Fig. 1. Geographical location of the under-mattress regular user’s sample.
Country by country prevalence of moderate-to-severe obstructive sleep apnea (OSA) (blue) and severe OSA (dark blue) is highlighted in the bar chart. Source data are provided as a Source Data file.
Fig. 2
Fig. 2. Cumulative exposure–response between ambient temperature and nightly obstructive sleep apnea (OSA) status per location.
a Exposure-response curves between temperature and the risk ratio (RR) for nightly OSA (solid green) or nightly severe OSA (dashed purple). Shaded area represents 95%CI. Distribution of temperature (histogram) and temperature at the 99th percentile (T99; dashed black line) are also highlighted. b Subgroup analyses including the mean RR (and 95%CI) for nightly OSA at T99 based on the country of residence’s gross domestic product (GDP) per capita (tertiles – N, tertile 1 :40152; tertile 2: 37722; tertile3: 38468). c RR for nightly OSA at T99 by geographical location. d Country by country analysis with mean RR (and 95%CI) for nightly OSA at 99th vs. 25th percentile of temperature (brown indicates p-values < 0.05 and purple p-values > 0.05). Exact N and RR (95%CI) for each country is available in Table S1. Source data are provided as a Source Data file.
Fig. 3
Fig. 3. Projected wellbeing burden of warming-related increase in moderate-to-severe obstructive sleep apnea (OSA) prevalence.
Wellbeing burden of warming-related increase in moderate-to-severe OSA prevalence is exemplified for the UK (a–c and d) and globally (e–g). a Historical and projected temperatures for different climate scenarios from the Intergovernmental Panel on Climate Change (IPCC) were used to (b) derive the number of additional person-days with OSA due to temperature increases, which were subsequently used to calculate (c) years lived with disability (YLD) and (d) years of life lost (YLL). Baseline temperatures were based on the historical 1950-1990 data. The wellbeing and economic impact of the estimated temperature-related increase in OSA by 2100 for different climate scenarios from the IPCC were calculated for (e) YLL, (f) YLD, and (g) wellbeing economic cost, expressed as rate per 100,000 persons per year. The white line-marker represents current rates (as of 2023) of YLL, YLD, and economic cost. Shaded area in the YLD graph represents the yearly wellbeing burden associated with OSA based on Australian estimates. USD US dollars, SSP Shared Socioeconomic Pathway. Source data are provided as a Source Data file.
Fig. 4
Fig. 4. Global projected workplace productivity loss from warming-related increase in moderate-to-severe obstructive sleep apnea (OSA) prevalence.
Calculated labor loss (in USD) for different climate scenarios from the Intergovernmental Panel on Climate Change (IPCC) (top) with different levels of future global warming over the 29 studied countries per (a) 100,000 people (mean and 95%CI across countries); (b) year. Cumulative sum of (c) absenteeism days, (d) presenteeism days, and (e) associated economic cost for different climate scenarios over the 2023–2100 period. Rates of (f) absenteeism (g) presenteeism, and (h) labor loss in 2100 per 100,000 people under different climate scenarios for the 29 studied countries. USD: US dollars; SSP: Shared Socioeconomic Pathway. Source data are provided as a Source Data file.
Fig. 5
Fig. 5. Example of methodological calculation of the warming-related increase in obstructive sleep apnea (OSA) prevalence for the UK.
a The difference in temperature for a given year (here 2023—black solid line) was compared to the 1950–1990 historical average temperature (dashed red line). b This difference in temperature (blue arrow) was used to calculate the change in the risk of nightly OSA between current vs. historical average temperature, for a particular day. This daily change was summed over the year and used to calculate the associated wellbeing and workplace productivity burden (see text for further details). Figure 5b represents the cumulative exposure–response (and 95%CI in shaded area) between ambient temperature and nightly OSA in the UK. Source data are provided as a Source Data file.
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