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Australia and OSA

Australians at risk of sleep apnoea as obesity levels rise

Over 25% of adult population at risk of OSA

Australia could be facing a sleep-disorder resources crisis, according to a study published in the Australian Health Review.  Researchers from the University of Adelaide have revealed that more than a quarter of Australians are at risk of obstructive sleep apnoea (OSA) and with obesity levels rising, they say an enormous strain will be placed on the healthcare system.

“Previous Australian research has found that 6% of the population report seeing their doctor for sleep apnoea or snoring, while only 2% report treatment for these conditions,” said Robert Adams, professor of medicine, University of Adelaide. “To reduce the rate of undiagnosed [and untreated] OSA, clinicians need to be aware that over a quarter of adults may need investigation for OSA, and should adopt an active approach to identifying people at risk.”

The study was designed to obtain prevalence estimates of clinical features of OSA and identify the dimensions of the public health problem requiring further investigation for an Australian population.

Using the South Australian Health Omnibus Survey, an annual representative population survey of South Australians aged 15 years or over. In 2009, 3,007 participants were asked the STOP-BANG instrument measure of obstructive sleep apnoea risk, which includes symptoms of loud snoring, frequent tiredness during daytime, observed apnoea, and high blood pressure (STOP), and measured body mass index, age, neck circumference and gender (BANG). Three or more positive response categorises a person at high risk for OSA.

Results

The outcomes revealed that 27.8% participants were classified at high risk of OSA. Snoring was reported by 49.7% of adults, tiredness after sleep more than 3 to 4 times per week was reported by 24.8%, and during wake-time by 27.7% of adults, with 8.8% reporting having fallen asleep while driving.

Over half of the surveyed men (57.1% or 566) and 19.3% (269) of the women were classified at high-risk of OSA. In multivariable models, high risk was associated with less education, lower income, and residence in a regional rather than metropolitan area.

The researchers concluded that the high prevalence of adults at risk for OSA suggests that the capacity currently available within the healthcare system to investigate and diagnose OSA is likely to be inadequate, particularly outside urban areas. This highlights a public health problem that requires further detailed study and trials of new models of care.

The researchers said that clinicians need to be aware that over a quarter of adults may need investigation for OSA, and should adopt an active approach to identifying people at risk. Health services and policy makers need to plan for this problem, and innovative approaches to provision of investigation and management need to be trialled.

“It is vital that health services and policy makers plan for this problem, and trial innovative approaches to provision of investigation and management, such as home-based testing and an expanded role for sleep nurses,” Professor Adams said.

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