Prevalence of obstructive sleep apnea syndrome in China: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

SU Xiaofeng ¹ , LIU lin ^2,3 , ZHONG Lin ¹ , QIAN Xiaoshun ² ,  HAN Jiming ¹

1. Medical College, Yan’an University, Yan’an 716000, P.R.China;
2. Department of Respiratory and Critical Care Medicine of the Second Medical Center, Chinese PLA General Hospital, Beijing 100853, P.R.China;
3. National Clinical Research Center for Geriatric Diseases, General Hospital of PLA, Beijing 100853, P.R.China;

Corresponding?author：

HAN Jiming, Email: yadxhjm@163.com

Keywords：

China; Obstructive sleep apnea syndrome; Epidemiology; Prevalence; Meta-analysis

DOI：

10.7507/1672-2531.202106103

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Objective To systematically review the prevalence of obstructive sleep apnea syndrome (OSAS) in China. Methods PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data, and VIP databases were electronically searched to collect cross-sectional studies of the prevalence of OSAS in China from inception to October 30^th, 2020. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Meta-analysis was then performed using Stata 16.0 software. Results A total of 27 studies were included, with a total sample size of 97 746 cases and 10 853 confirmed OSAS patients. Meta-analysis results showed that the prevalence of OSAS in China was 11% (95%CI 5% to 17%), of which females was 12% (95%CI 5% to 19%) and males was 12% (95%CI 5% to 20%). OSAS cases grouped by regions were as follows: Central China 4% (95%CI 2.7% to 4.5%), South China 5% (95%CI 2.7% to 6.7%), North China 7% (95%CI 4.6% to 9.3%), Northeast China 22% (95%CI 17.7% to 61.2%), Southwest China 4% (95%CI 3.2% to 5%), Northwest China 16% (95%CI 14.5% to 17.7%), and East China 17% (95%CI 2.8% to 30.6%). OSAS patients grouped by ages were as follows: 4% (95%CI 3% to 5%) for ≤14 years old, 5% (95%CI 2% to 7%) for 15-44 years old, 13% (95%CI 6% to 20%) for 45-59 years old, 16% (95%CI 6% to 25%) for 60-74 years old, 13% (95%CI 4% to 23%) for 75-89 years old, and 11% (95%CI 2% to 21%) for ≥ 90 years old. A subgroup analysis based on the year of publication found that the prevalence of OSAS fluctuated between 6% and 9% from 2005 to 2020, and the prevalence was the highest from 2000 to 2005 accouted with 21% (95%CI 0.8% to 40.5%). Conclusions The prevalence of OSAS in China is relatively high, and there are differences in the prevalence among individuals of different ages and regions. The 60-year-old groups in addition to the Northeast and East China regions have a high incidence. The prevalence of OSAS is substantially consistent between males and females. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.

Citation： SU Xiaofeng, LIU lin, ZHONG Lin, QIAN Xiaoshun, HAN Jiming. Prevalence of obstructive sleep apnea syndrome in China: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(10): 1187-1194. doi: 10.7507/1672-2531.202106103 Copy

1.	Veasey SC, Rosen IM. Obstructive sleep apnea in adults. N Engl J Med, 2019, 380(15): 1442-1449.
2.	Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol, 2013, 177(9): 1006-1014.
3.	Marshall NS, Wong KK, Cullen SR, et al. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort. J Clin Sleep Med, 2014, 10(4): 355-362.
4.	Chen X, Wang R, Zee P, et al. Racial/Ethnic differences in sleep disturbances: the multi-ethnic study of atherosclerosis (MESA). Sleep, 2015, 38(6): 877-888.
5.	Matsumoto T, Chin K. Prevalence of sleep disturbances: sleep disordered breathing, short sleep duration, and non-restorative sleep. Respir Investig, 2019, 57(3): 227-237.
6.	Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American academy of sleep medicine clinical practice guideline. J Clin Sleep Med, 2017, 13(3): 479-504.
7.	曾憲濤, 劉慧, 陳曦, 等. Meta 分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
8.	石修權, 王增珍. Egger’s test 與 Begg’s test 的功效差異比較與原因分析. 華中科技大學學報(醫學版), 2009, 38(1): 91-93+102.
9.	Ip MS, Lam B, Lauder IJ, et al. A community study of sleep-disordered breathing in middle-aged Chinese men in Hong Kong. Chest, 2001, 119(1): 62-69.
10.	Ip MS, Lam B, Tang LC, et al. A community study of sleep-disordered breathing in middle-aged Chinese women in Hong Kong: prevalence and gender differences. Chest, 2004, 125(1): 127-134.
11.	Liu J, Wei C, Huang L, et al. Prevalence of signs and symptoms suggestive of obstructive sleep apnea syndrome in Guangxi, China. Sleep Breath, 2014, 18(2): 375-382.
12.	Ng SS, Chan TO, To KW, et al. Prevalence of obstructive sleep apnea syndrome and CPAP adherence in the elderly Chinese population. PLoS One, 2015, 10(3): e0119829.
13.	Wei W. Prevalence and risk factors of obstructive sleep apnea syndrome in 3-14 years old children in Beijing: a cross-sectional survey abstract. Sleep, 2020, 43(Suppl 1): A346.
14.	高云云, 張秀華, 曾海環, 等. 阻塞性睡眠呼吸暫停低通氣綜合征相關因素的初步分析. 中國醫刊, 2010, 45(2): 54-56.
15.	洪培川, 歐瓊, 潘敏霞, 等. 公務員人群對打鼾危害的認知度及阻塞性睡眠呼吸暫停患病率現狀調查. 中華結核和呼吸雜志, 2020, 43(7): 553-556.
16.	侯冬青, 王湘富, 楊輝紅, 等. 阻塞性睡眠呼吸暫停低通氣綜合征的臨床流行病學調查及相關因素分析. 醫學臨床研究, 2006, 23(3): 297-299.
17.	胡慶磊, 杜翠萍, 楊揚, 等. 上海市普陀區 20 歲以上人群阻塞性睡眠呼吸暫停低通氣綜合征流行病學調查. 中國眼耳鼻喉科雜志, 2017, 17(1): 49-54.
18.	胡一多, 韓宇丹, 王越, 等. 阻塞性睡眠呼吸暫停低通氣綜合征發病情況調查. 臨床耳鼻咽喉頭頸外科雜志, 2007, 21(21): 1007-1008.
19.	靳秀宏, 董強, 趙晶晶, 等. 基層公務員阻塞性睡眠呼吸暫停低通氣綜合征的調查分析. 中國醫刊, 2016, 51(8): 95-98.
20.	李明嫻, 王瑩, 華樹成, 等. 長春市 20 歲以上人群阻塞性睡眠呼吸暫停低通氣綜合征流行病學現況調查. 中華結核和呼吸雜志, 2005, 28(12): 833-835.
21.	林其昌, 黃建釵, 丁海波, 等. 福州市區老年人阻塞性睡眠呼吸暫停低通氣綜合征流行病學調查. 中華老年醫學雜志, 2010, 29(4): 332-335.
22.	林其昌, 黃建釵, 丁海波, 等. 福州市 20 歲以上人群阻塞性睡眠呼吸暫停低通氣綜合征流行病學調查. 中華結核和呼吸雜志, 2009, 32(3): 193-197.
23.	劉建紅, 韋彩周, 黃陸穎, 等. 廣西地區打鼾及阻塞性睡眠呼吸暫停低通氣綜合征的流行病學調查. 中華流行病學雜志, 2007, 28(2): 115-118.
24.	馬國強, 代國儀, 李繼平, 等. 內蒙古東烏旗 20 歲以上牧區人群阻塞性睡眠呼吸暫停低通氣綜合征流行病學調查. 中華臨床醫師雜志(電子版), 2010, 4(7): 1070-1073.
25.	龐劍, 劉杰峰, 段建寶, 等. 飛行員阻塞性睡眠呼吸暫停低通氣綜合征的調查. 中華航空航天醫學雜志, 2016, 27(3): 180-183.
26.	秦化祥, 林佳, 吳琬, 等. 溫州青年學生鼾癥和阻塞性睡眠呼吸暫停低通氣綜合征調查. 口腔醫學研究, 2009, 25(4): 515-517.
27.	上海市醫學會呼吸病學分會睡眠呼吸疾病學組. 上海市 30 歲以上人群阻塞性睡眠呼吸暫停低通氣綜合征流行病學調查. 中華結核和呼吸雜志, 2003, 26(5): 268-272.
28.	蘇軼, 徐偉偉, 王向云, 等. 東營市東營區老年人阻塞性睡眠呼吸暫停低通氣綜合征流行病學調查. 臨床耳鼻咽喉頭頸外科雜志, 2016, 30(4): 299-305.
29.	王蓓, 邢景才, 韓長旭, 等. 太原市睡眠呼吸暫停低通氣綜合征的流行病學調查. 中華結核和呼吸雜志, 2004, 27(11): 760-762.
30.	謝允平, 何建平, 陳才軍, 等. 男性基層官兵阻塞性睡眠呼吸暫停低通氣綜合征危險因素分析. 中國耳鼻咽喉顱底外科雜志, 2020, 26(5): 559-564.
31.	葉京英, 王小軼, 韓德民, 等. 中老年女性阻塞性睡眠呼吸暫停低通氣綜合征的社區調查. 中華耳鼻咽喉頭頸外科雜志, 2005, 40(8): 611-617.
32.	張慶, 何權瀛, 杜秋艷, 等. 承德市區居民睡眠呼吸暫停低通氣綜合征患病率入戶調查. 中華結核和呼吸雜志, 2003, 26(5): 273-275.
33.	張小平, 楊登權, 黃小明, 等. 宜賓市 6~12 歲兒童阻塞性睡眠呼吸暫停低通氣綜合征患病情況及生活質量調查. 安徽醫學, 2019, 40(5): 585-589.
34.	趙陽, 李建瑞, 王利偉, 等. 北京市朝陽區成人打鼾及阻塞性睡眠呼吸暫停低通氣綜合征流行病學調查. 中國醫藥導報, 2013, 10(27): 108-111.
35.	鄒小量, 朱勝華, 李多洛, 等. 邵陽市 20 歲以上人群阻塞性睡眠呼吸暫停低通氣綜合征的流行病學調查. 中國現代醫學雜志, 2007, 17(8): 956-959.
36.	Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev, 2017, 34: 70-81.
37.	Fietze I, Laharnar N, Obst A, et al. Prevalence and association analysis of obstructive sleep apnea with gender and age differences - Results of SHIP-Trend. J Sleep Res, 2019, 28(5): e12770.
38.	Lee SD, Kang SH, Ju G, et al. The prevalence of and risk factors for sleep-disordered breathing in an elderly Korean population. Respiration, 2014, 87(5): 372-378.
39.	趙顯超, 程金湘, 雷革勝, 等. 單中心 8037 例睡眠障礙患者的流行病學及臨床特征分析. 中華神經科雜志, 2017, 50(8): 579-584.
40.	Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med, 2015, 3(4): 310-318.
41.	Tufik S, Santos-Silva R, Taddei JA, et al. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med, 2010, 11(5): 441-446.
42.	劉春風, 李潔. 卒中患者中常被忽視的睡眠障礙. 中國卒中雜志, 2019, 14(4): 305-308.

1. Veasey SC, Rosen IM. Obstructive sleep apnea in adults. N Engl J Med, 2019, 380(15): 1442-1449.
2. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol, 2013, 177(9): 1006-1014.
3. Marshall NS, Wong KK, Cullen SR, et al. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort. J Clin Sleep Med, 2014, 10(4): 355-362.
4. Chen X, Wang R, Zee P, et al. Racial/Ethnic differences in sleep disturbances: the multi-ethnic study of atherosclerosis (MESA). Sleep, 2015, 38(6): 877-888.
5. Matsumoto T, Chin K. Prevalence of sleep disturbances: sleep disordered breathing, short sleep duration, and non-restorative sleep. Respir Investig, 2019, 57(3): 227-237.
6. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American academy of sleep medicine clinical practice guideline. J Clin Sleep Med, 2017, 13(3): 479-504.
7. 曾憲濤, 劉慧, 陳曦, 等. Meta 分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
8. 石修權, 王增珍. Egger’s test 與 Begg’s test 的功效差異比較與原因分析. 華中科技大學學報(醫學版), 2009, 38(1): 91-93+102.
9. Ip MS, Lam B, Lauder IJ, et al. A community study of sleep-disordered breathing in middle-aged Chinese men in Hong Kong. Chest, 2001, 119(1): 62-69.
10. Ip MS, Lam B, Tang LC, et al. A community study of sleep-disordered breathing in middle-aged Chinese women in Hong Kong: prevalence and gender differences. Chest, 2004, 125(1): 127-134.
11. Liu J, Wei C, Huang L, et al. Prevalence of signs and symptoms suggestive of obstructive sleep apnea syndrome in Guangxi, China. Sleep Breath, 2014, 18(2): 375-382.
12. Ng SS, Chan TO, To KW, et al. Prevalence of obstructive sleep apnea syndrome and CPAP adherence in the elderly Chinese population. PLoS One, 2015, 10(3): e0119829.
13. Wei W. Prevalence and risk factors of obstructive sleep apnea syndrome in 3-14 years old children in Beijing: a cross-sectional survey abstract. Sleep, 2020, 43(Suppl 1): A346.
14. 高云云, 張秀華, 曾海環, 等. 阻塞性睡眠呼吸暫停低通氣綜合征相關因素的初步分析. 中國醫刊, 2010, 45(2): 54-56.
15. 洪培川, 歐瓊, 潘敏霞, 等. 公務員人群對打鼾危害的認知度及阻塞性睡眠呼吸暫停患病率現狀調查. 中華結核和呼吸雜志, 2020, 43(7): 553-556.
16. 侯冬青, 王湘富, 楊輝紅, 等. 阻塞性睡眠呼吸暫停低通氣綜合征的臨床流行病學調查及相關因素分析. 醫學臨床研究, 2006, 23(3): 297-299.
17. 胡慶磊, 杜翠萍, 楊揚, 等. 上海市普陀區 20 歲以上人群阻塞性睡眠呼吸暫停低通氣綜合征流行病學調查. 中國眼耳鼻喉科雜志, 2017, 17(1): 49-54.
18. 胡一多, 韓宇丹, 王越, 等. 阻塞性睡眠呼吸暫停低通氣綜合征發病情況調查. 臨床耳鼻咽喉頭頸外科雜志, 2007, 21(21): 1007-1008.
19. 靳秀宏, 董強, 趙晶晶, 等. 基層公務員阻塞性睡眠呼吸暫停低通氣綜合征的調查分析. 中國醫刊, 2016, 51(8): 95-98.
20. 李明嫻, 王瑩, 華樹成, 等. 長春市 20 歲以上人群阻塞性睡眠呼吸暫停低通氣綜合征流行病學現況調查. 中華結核和呼吸雜志, 2005, 28(12): 833-835.
21. 林其昌, 黃建釵, 丁海波, 等. 福州市區老年人阻塞性睡眠呼吸暫停低通氣綜合征流行病學調查. 中華老年醫學雜志, 2010, 29(4): 332-335.
22. 林其昌, 黃建釵, 丁海波, 等. 福州市 20 歲以上人群阻塞性睡眠呼吸暫停低通氣綜合征流行病學調查. 中華結核和呼吸雜志, 2009, 32(3): 193-197.
23. 劉建紅, 韋彩周, 黃陸穎, 等. 廣西地區打鼾及阻塞性睡眠呼吸暫停低通氣綜合征的流行病學調查. 中華流行病學雜志, 2007, 28(2): 115-118.
24. 馬國強, 代國儀, 李繼平, 等. 內蒙古東烏旗 20 歲以上牧區人群阻塞性睡眠呼吸暫停低通氣綜合征流行病學調查. 中華臨床醫師雜志(電子版), 2010, 4(7): 1070-1073.
25. 龐劍, 劉杰峰, 段建寶, 等. 飛行員阻塞性睡眠呼吸暫停低通氣綜合征的調查. 中華航空航天醫學雜志, 2016, 27(3): 180-183.
26. 秦化祥, 林佳, 吳琬, 等. 溫州青年學生鼾癥和阻塞性睡眠呼吸暫停低通氣綜合征調查. 口腔醫學研究, 2009, 25(4): 515-517.
27. 上海市醫學會呼吸病學分會睡眠呼吸疾病學組. 上海市 30 歲以上人群阻塞性睡眠呼吸暫停低通氣綜合征流行病學調查. 中華結核和呼吸雜志, 2003, 26(5): 268-272.
28. 蘇軼, 徐偉偉, 王向云, 等. 東營市東營區老年人阻塞性睡眠呼吸暫停低通氣綜合征流行病學調查. 臨床耳鼻咽喉頭頸外科雜志, 2016, 30(4): 299-305.
29. 王蓓, 邢景才, 韓長旭, 等. 太原市睡眠呼吸暫停低通氣綜合征的流行病學調查. 中華結核和呼吸雜志, 2004, 27(11): 760-762.
30. 謝允平, 何建平, 陳才軍, 等. 男性基層官兵阻塞性睡眠呼吸暫停低通氣綜合征危險因素分析. 中國耳鼻咽喉顱底外科雜志, 2020, 26(5): 559-564.
31. 葉京英, 王小軼, 韓德民, 等. 中老年女性阻塞性睡眠呼吸暫停低通氣綜合征的社區調查. 中華耳鼻咽喉頭頸外科雜志, 2005, 40(8): 611-617.
32. 張慶, 何權瀛, 杜秋艷, 等. 承德市區居民睡眠呼吸暫停低通氣綜合征患病率入戶調查. 中華結核和呼吸雜志, 2003, 26(5): 273-275.
33. 張小平, 楊登權, 黃小明, 等. 宜賓市 6~12 歲兒童阻塞性睡眠呼吸暫停低通氣綜合征患病情況及生活質量調查. 安徽醫學, 2019, 40(5): 585-589.
34. 趙陽, 李建瑞, 王利偉, 等. 北京市朝陽區成人打鼾及阻塞性睡眠呼吸暫停低通氣綜合征流行病學調查. 中國醫藥導報, 2013, 10(27): 108-111.
35. 鄒小量, 朱勝華, 李多洛, 等. 邵陽市 20 歲以上人群阻塞性睡眠呼吸暫停低通氣綜合征的流行病學調查. 中國現代醫學雜志, 2007, 17(8): 956-959.
36. Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev, 2017, 34: 70-81.
37. Fietze I, Laharnar N, Obst A, et al. Prevalence and association analysis of obstructive sleep apnea with gender and age differences - Results of SHIP-Trend. J Sleep Res, 2019, 28(5): e12770.
38. Lee SD, Kang SH, Ju G, et al. The prevalence of and risk factors for sleep-disordered breathing in an elderly Korean population. Respiration, 2014, 87(5): 372-378.
39. 趙顯超, 程金湘, 雷革勝, 等. 單中心 8037 例睡眠障礙患者的流行病學及臨床特征分析. 中華神經科雜志, 2017, 50(8): 579-584.
40. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med, 2015, 3(4): 310-318.
41. Tufik S, Santos-Silva R, Taddei JA, et al. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med, 2010, 11(5): 441-446.
42. 劉春風, 李潔. 卒中患者中常被忽視的睡眠障礙. 中國卒中雜志, 2019, 14(4): 305-308.

Chinese Journal of Evidence-Based Medicine

Prevalence of obstructive sleep apnea syndrome in China: a meta-analysis

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