Why are people with sleep apnea undiagnosed? – The SCAPIS Sleep Cohort

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Introduction: People are advised to seek medical attention for obstructive sleep apnea (OSA) if they snore, feel tired, or suffer from atrial fibrillation. This study aimed to identify factors contributing to the underdiagnosis of sleep apnea. Methods: Data were collected from overnight polygraphy, questionnaires, and anthropometric measurements in 9,020 men and women (aged 50-64 years) participating in the Swedish CArdioPulmonary bioimage Study (SCAPIS) sleep cohort from Gothenburg, Uppsala, and Umeå. Results: Complete data were obtained from 8,707 individuals (54% women, 46% men), with a mean age of 57.5 ±4.3 years and a mean BMI of 26.9 ±4.3 kg/m². Previously diagnosed sleep apnea was present in 3% of participants, while 11% (17% of men and 7% of women) had undiagnosed moderate-to-severe OSA (apnea-hypopnea index ≥15). Compared to those with previously diagnosed OSA, individuals with undiagnosed OSA reported significantly lower occurrences of snoring (19% vs. 43%), witnessed apneas (21% vs. 71%), excessive daytime sleepiness (ESS>10, 19% vs. 27%), and atrial fibrillation (2.5% vs. 4.9%). Undiagnosed individuals had a lower education level (38% vs. 49% with a university degree). There were no differences in BMI, sex, alcohol consumption, smoking history, country of birth, hypertension, heart failure, unemployment rate, or living alone. Conclusion: Most people with sleep apnea remain undiagnosed and asymptomatic. Current recommendations to seek medical attention for symptoms such as snoring, witnessed apnea, daytime sleepiness, and atrial fibrillation primarily target a minority of affected individuals, contributing to the high rate of undiagnosed cases.

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