A population-based estimate of the health care burden of obstructive sleep apnea using a STOP-BAG questionnaire in South Carolina.

STUDY OBJECTIVES: Population based estimates of obstructive sleep apnea (OSA) frequency and health impact are incomplete. The aim of this study was to determine the prevalence of risk factors for physician and sleep study diagnosed OSA among individuals in a state-based surveillance program.

METHODS: Using questions inserted into the 2016 (N=5564) and 2017 (N=10884) South Carolina Behavioral Risk Factor Surveillance System (BRFSS) of the Centers for Disease Control and Prevention, we analyzed the prevalence of physician diagnosed OSA and associated comorbidities. The validated STOP-BANG questionnaire without neck circumference (STOP-BAG) defined moderate risk (score 3-4) and high risk (score 5-7) populations. Statistical analysis using weighted prevalence and means and their 95% confidence intervals thus reflect population estimates of disease burden.

RESULTS: The population-based prevalence of physician diagnosed OSA in South Carolina was 9.7% (95% CI: 9.0-10.4). However, the populations with moderate risk (18.5%, 95% CI 17.3-19.8) and high risk (25.5%, 95% CI 23.9-27.1) for OSA as determined by the STOP-BAG questionnaire were much higher. Compared to those at low risk for OSA, those at high risk were more often diagnosed with coronary heart disease, stroke, asthma, skin cancer, other cancers, chronic obstructive pulmonary disease (COPD), arthritis, depression, kidney disease, and diabetes (all p<0.001).

CONCLUSIONS: OSA is common and strongly associated with major comorbidities. As such, this public health crisis warrants more diagnostic and therapeutic attention. The STOP-BAG questionnaire provides a public health platform to monitor this disease.