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.	曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
8.	石修权, 王增珍. Egger’s test 与 Begg’s test 的功效差异比较与原因分析. 华中科技大学学报(医学版), 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, 张秀华, 曾海环, 等. 阻塞性睡眠呼吸暂停低通气综合征相关因素的初步分析. 中国医刊, 2010, 45(2): 54-56.
15.	洪培川, 欧琼, 潘敏霞, 等. 公务员人群对打鼾危害的认知度及阻塞性睡眠呼吸暂停患病率现状调查. 中华结核和呼吸杂志, 2020, 43(7): 553-556.
16.	侯冬青, 王湘富, 杨辉红, 等. 阻塞性睡眠呼吸暂停低通气综合征的临床流行病学调查及相关因素分析. 医学临床研究, 2006, 23(3): 297-299.
17.	胡庆磊, 杜翠萍, 杨扬, 等. 上海市普陀区 20 岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学调查. 中国眼耳鼻喉科杂志, 2017, 17(1): 49-54.
18.	胡一多, 韩宇丹, 王越, 等. 阻塞性睡眠呼吸暂停低通气综合征发病情况调查. 临床耳鼻咽喉头颈外科杂志, 2007, 21(21): 1007-1008.
19.	靳秀宏, 董强, 赵晶晶, 等. 基层公务员阻塞性睡眠呼吸暂停低通气综合征的调查分析. 中国医刊, 2016, 51(8): 95-98.
20.	李明娴, 王莹, 华树成, 等. 长春市 20 岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学现况调查. 中华结核和呼吸杂志, 2005, 28(12): 833-835.
21.	林其昌, 黄建钗, 丁海波, 等. 福州市区老年人阻塞性睡眠呼吸暂停低通气综合征流行病学调查. 中华老年医学杂志, 2010, 29(4): 332-335.
22.	林其昌, 黄建钗, 丁海波, 等. 福州市 20 岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学调查. 中华结核和呼吸杂志, 2009, 32(3): 193-197.
23.	刘建红, 韦彩周, 黄陆颖, 等. 广西地区打鼾及阻塞性睡眠呼吸暂停低通气综合征的流行病学调查. 中华流行病学杂志, 2007, 28(2): 115-118.
24.	马国强, 代国仪, 李继平, 等. 内蒙古东乌旗 20 岁以上牧区人群阻塞性睡眠呼吸暂停低通气综合征流行病学调查. 中华临床医师杂志(电子版), 2010, 4(7): 1070-1073.
25.	庞剑, 刘杰峰, 段建宝, 等. 飞行员阻塞性睡眠呼吸暂停低通气综合征的调查. 中华航空航天医学杂志, 2016, 27(3): 180-183.
26.	秦化祥, 林佳, 吴琬, 等. 温州青年学生鼾症和阻塞性睡眠呼吸暂停低通气综合征调查. 口腔医学研究, 2009, 25(4): 515-517.
27.	上海市医学会呼吸病学分会睡眠呼吸疾病学组. 上海市 30 岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学调查. 中华结核和呼吸杂志, 2003, 26(5): 268-272.
28.	苏轶, 徐伟伟, 王向云, 等. 东营市东营区老年人阻塞性睡眠呼吸暂停低通气综合征流行病学调查. 临床耳鼻咽喉头颈外科杂志, 2016, 30(4): 299-305.
29.	王蓓, 邢景才, 韩长旭, 等. 太原市睡眠呼吸暂停低通气综合征的流行病学调查. 中华结核和呼吸杂志, 2004, 27(11): 760-762.
30.	谢允平, 何建平, 陈才军, 等. 男性基层官兵阻塞性睡眠呼吸暂停低通气综合征危险因素分析. 中国耳鼻咽喉颅底外科杂志, 2020, 26(5): 559-564.
31.	叶京英, 王小轶, 韩德民, 等. 中老年女性阻塞性睡眠呼吸暂停低通气综合征的社区调查. 中华耳鼻咽喉头颈外科杂志, 2005, 40(8): 611-617.
32.	张庆, 何权瀛, 杜秋艳, 等. 承德市区居民睡眠呼吸暂停低通气综合征患病率入户调查. 中华结核和呼吸杂志, 2003, 26(5): 273-275.
33.	张小平, 杨登权, 黄小明, 等. 宜宾市 6~12 岁儿童阻塞性睡眠呼吸暂停低通气综合征患病情况及生活质量调查. 安徽医学, 2019, 40(5): 585-589.
34.	赵阳, 李建瑞, 王利伟, 等. 北京市朝阳区成人打鼾及阻塞性睡眠呼吸暂停低通气综合征流行病学调查. 中国医药导报, 2013, 10(27): 108-111.
35.	邹小量, 朱胜华, 李多洛, 等. 邵阳市 20 岁以上人群阻塞性睡眠呼吸暂停低通气综合征的流行病学调查. 中国现代医学杂志, 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.	赵显超, 程金湘, 雷革胜, 等. 单中心 8037 例睡眠障碍患者的流行病学及临床特征分析. 中华神经科杂志, 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.	刘春风, 李洁. 卒中患者中常被忽视的睡眠障碍. 中国卒中杂志, 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. 曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
8. 石修权, 王增珍. Egger’s test 与 Begg’s test 的功效差异比较与原因分析. 华中科技大学学报(医学版), 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, 张秀华, 曾海环, 等. 阻塞性睡眠呼吸暂停低通气综合征相关因素的初步分析. 中国医刊, 2010, 45(2): 54-56.
15. 洪培川, 欧琼, 潘敏霞, 等. 公务员人群对打鼾危害的认知度及阻塞性睡眠呼吸暂停患病率现状调查. 中华结核和呼吸杂志, 2020, 43(7): 553-556.
16. 侯冬青, 王湘富, 杨辉红, 等. 阻塞性睡眠呼吸暂停低通气综合征的临床流行病学调查及相关因素分析. 医学临床研究, 2006, 23(3): 297-299.
17. 胡庆磊, 杜翠萍, 杨扬, 等. 上海市普陀区 20 岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学调查. 中国眼耳鼻喉科杂志, 2017, 17(1): 49-54.
18. 胡一多, 韩宇丹, 王越, 等. 阻塞性睡眠呼吸暂停低通气综合征发病情况调查. 临床耳鼻咽喉头颈外科杂志, 2007, 21(21): 1007-1008.
19. 靳秀宏, 董强, 赵晶晶, 等. 基层公务员阻塞性睡眠呼吸暂停低通气综合征的调查分析. 中国医刊, 2016, 51(8): 95-98.
20. 李明娴, 王莹, 华树成, 等. 长春市 20 岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学现况调查. 中华结核和呼吸杂志, 2005, 28(12): 833-835.
21. 林其昌, 黄建钗, 丁海波, 等. 福州市区老年人阻塞性睡眠呼吸暂停低通气综合征流行病学调查. 中华老年医学杂志, 2010, 29(4): 332-335.
22. 林其昌, 黄建钗, 丁海波, 等. 福州市 20 岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学调查. 中华结核和呼吸杂志, 2009, 32(3): 193-197.
23. 刘建红, 韦彩周, 黄陆颖, 等. 广西地区打鼾及阻塞性睡眠呼吸暂停低通气综合征的流行病学调查. 中华流行病学杂志, 2007, 28(2): 115-118.
24. 马国强, 代国仪, 李继平, 等. 内蒙古东乌旗 20 岁以上牧区人群阻塞性睡眠呼吸暂停低通气综合征流行病学调查. 中华临床医师杂志(电子版), 2010, 4(7): 1070-1073.
25. 庞剑, 刘杰峰, 段建宝, 等. 飞行员阻塞性睡眠呼吸暂停低通气综合征的调查. 中华航空航天医学杂志, 2016, 27(3): 180-183.
26. 秦化祥, 林佳, 吴琬, 等. 温州青年学生鼾症和阻塞性睡眠呼吸暂停低通气综合征调查. 口腔医学研究, 2009, 25(4): 515-517.
27. 上海市医学会呼吸病学分会睡眠呼吸疾病学组. 上海市 30 岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学调查. 中华结核和呼吸杂志, 2003, 26(5): 268-272.
28. 苏轶, 徐伟伟, 王向云, 等. 东营市东营区老年人阻塞性睡眠呼吸暂停低通气综合征流行病学调查. 临床耳鼻咽喉头颈外科杂志, 2016, 30(4): 299-305.
29. 王蓓, 邢景才, 韩长旭, 等. 太原市睡眠呼吸暂停低通气综合征的流行病学调查. 中华结核和呼吸杂志, 2004, 27(11): 760-762.
30. 谢允平, 何建平, 陈才军, 等. 男性基层官兵阻塞性睡眠呼吸暂停低通气综合征危险因素分析. 中国耳鼻咽喉颅底外科杂志, 2020, 26(5): 559-564.
31. 叶京英, 王小轶, 韩德民, 等. 中老年女性阻塞性睡眠呼吸暂停低通气综合征的社区调查. 中华耳鼻咽喉头颈外科杂志, 2005, 40(8): 611-617.
32. 张庆, 何权瀛, 杜秋艳, 等. 承德市区居民睡眠呼吸暂停低通气综合征患病率入户调查. 中华结核和呼吸杂志, 2003, 26(5): 273-275.
33. 张小平, 杨登权, 黄小明, 等. 宜宾市 6~12 岁儿童阻塞性睡眠呼吸暂停低通气综合征患病情况及生活质量调查. 安徽医学, 2019, 40(5): 585-589.
34. 赵阳, 李建瑞, 王利伟, 等. 北京市朝阳区成人打鼾及阻塞性睡眠呼吸暂停低通气综合征流行病学调查. 中国医药导报, 2013, 10(27): 108-111.
35. 邹小量, 朱胜华, 李多洛, 等. 邵阳市 20 岁以上人群阻塞性睡眠呼吸暂停低通气综合征的流行病学调查. 中国现代医学杂志, 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. 赵显超, 程金湘, 雷革胜, 等. 单中心 8037 例睡眠障碍患者的流行病学及临床特征分析. 中华神经科杂志, 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. 刘春风, 李洁. 卒中患者中常被忽视的睡眠障碍. 中国卒中杂志, 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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