Prevalence and Risk Factors for OSA among Urban and Rural Subjects in Bengaluru District, South India: A Cross-sectional Study
Uma Devaraj, Uma Maheswari Krishnaswamy, Sujana Balla, Ashna M Pinto, Kavitha Venkatnarayan, Priya Ramachandran, Chitra Veluthat, George D Souza
Berlin questionnaire, Epworth sleepiness scale, Level III sleep study, Obstructive sleep apnea, Rural and urban setting
Citation Information :
Devaraj U, Krishnaswamy UM, Balla S, Pinto AM, Venkatnarayan K, Ramachandran P, Veluthat C, Souza GD. Prevalence and Risk Factors for OSA among Urban and Rural Subjects in Bengaluru District, South India: A Cross-sectional Study. Indian Sleep Med 2021; 16 (1):5-9.
Introduction: Prevalence rates of obstructive sleep apnea (OSA) in India vary widely due to diverse study settings. Besides, the literature comparing the prevalence of OSA between urban and rural settings is sparse. Aims and objectives: To determine prevalence and risk factors for OSA among urban and rural South Indian subjects. Materials and methods: This prospective study was carried out in seven census blocks in Bengaluru and seven villages in Anekal taluk. Clinical data were collected; Epworth sleepiness scale and Berlin questionnaire were used to screen for sleepiness and OSA, respectively. Subjects deemed high risk for OSA during screening underwent level III sleep study. Results: A total of 709 subjects (388 urban and 321 rural) were included. The mean age was 35.5 ± 10.6 years (urban subjects) and 39.4 ± 15.6 years (rural subjects). Those at risk of OSA after screening were 36 (6.7%) and 28 (8.7%) among urban and rural participants, respectively. The prevalence of OSA was 18 (4.6%) in urban and 12 (3.7%) in rural subjects. Discussion: The urban OSA group had significantly higher body mass index (27.6 vs 24.2 kg/m2; p = 0.05) and neck circumference (38.9 vs 34.4 cm; p = 0.0001). Although the overall prevalence of OSA was similar in both groups, urban subjects had a significantly higher prevalence of severe OSA (44 vs 8.4%). Conclusion: Prevalence of OSA was similar in urban and rural subjects but risk factors and OSA severity showed variation between the two groups, with urban subjects having unfavorable anthropometry and a higher proportion of severe OSA.
Rodenstein D. Sleep apnea: traffic and occupational accidents—individual risks, socioeconomic and legal implications. Respiration 2009;78(3):241–248. DOI: 10.1159/000222811.
Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328(17):1230–1235. DOI: 10.1056/NEJM199304293281704.
Parish JM, Shepard Jr JW. Cardiovascular effects of sleep disorders. Chest 1990;97(5):1220–1226. DOI: 10.1378/chest.97.5.1220.
Ifergane G, Ovanyan A, Toledano R, et al. Obstructive sleep apnea in acute stroke: a role for systemic inflammation. Stroke 2016;47(5):1207–1212. DOI: 10.1161/STROKEAHA.115.011749.
Soriano JB, Yáñez A, Renom F, et al. Set-up and pilot of a population cohort for the study of the natural history of COPD and OSA: the PULSAIB study. Prim Care Respir J 2010;19(2):140–147. DOI: 10.4104/pcrj.2010.00010.
Gay P, Weaver T, Loube D, et al. Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 2006;29(3):381–401. DOI: 10.1093/sleep/29.3.381.
Singh A, Prasad R, Garg R, et al. A study to estimate prevalence and risk factors of obstructive sleep apnoea syndrome in a semi-urban Indian population. Monaldi Arch Chest Dis 2017;87:40–48. DOI: 10.4081/monaldi.2017.773
Reddy EV, Kadhiravan T, Mishra HK, et al. Prevalence and risk factors of obstructive sleep apnea among middle-aged urban Indians: a community-based study. Sleep Med 2009;10(8):913–918. DOI: 10.1016/j.sleep.2008.08.011.
Udwadia ZF, Doshi AV, Lonkar SG, et al. Prevalence of sleep-disordered breathing and sleep apnea in middle-aged urban Indian men. Am J Respir Crit Care Med 2004;169(2):168–173. DOI: 10.1164/rccm.200302-265OC.
Bhushan B, Misra A, Guleria R. Obstructive sleep apnea is independently associated with the metabolic syndrome in obese Asian Indians in northern India. Metab Syndr Relat Disord 2010;8(5):431–435. DOI: 10.1089/met.2009.0125.
Pinto AM, Devaraj U, Ramachandran P, et al. Obstructive Sleep Apnea in a rural population in South India: feasibility of health care workers to administer level III sleep study. Lung India 2018;35(4):301–306. DOI: 10.4103/lungindia.lungindia_433_17.
Choudhury A, Routray D, Swain S, et al. Prevalence and risk factors of people at-risk of obstructive sleep apnea in a rural community of Odisha, India: a community based cross-sectional study. Sleep Med 2019;58:42–47. DOI: 10.1016/j.sleep.2019.03.014.
Berry RB, Brooks R, Gamaldo CE, et al. The AASM manual for the scoring of sleep and associated events; n.d. Available from: http://www.aasmnet.org/resources/pdf/scoring-manual-preface.pdf [accessed March 23, 2017].
Adesanya AO, Lee W, Greilich NB, et al. Perioperative management of obstructive sleep apnea. Chest 2010;138(6):1489–1498. DOI: 10.1378/chest.10-1108.
Coman AC, Borzan C, Vesa CS, et al. Obstructive sleep apnea syndrome and the quality of life. Clujul Med 2016;89(3):390–395. DOI: 10.15386/cjmed-593.
Vakulin A, Baulk SD, Catcheside PG, et al. Driving simulator performance remains impaired in patients with severe OSA after CPAP treatment. J Clin Sleep Med 2011;7(3):246–253. DOI: 10.5664/JCSM.1062.
Sharma SK, Reddy EV, Sharma A, et al. Prevalence and risk factors of syndrome Z in urban Indians. Sleep Med 2010;11(6):562–568. DOI: 10.1016/j.sleep.2010.02.008.
Sharma SK, Kumpawat S, Banga A, et al. Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India. Chest 2006;130(1):149–156. DOI: 10.1378/chest.130.1.149.
Nickerson J, Lee E, Nedelman M, et al. Feasibility of portable sleep monitors to detect obstructive sleep apnea (OSA) in a vulnerable urban population HHS public access. J Am Board Fam Med 2015;28(2):257–264. DOI: 10.3122/jabfm.2015.02.140273.
Burgess KR, Havryk A, Newton S, et al. Targeted case finding for OSA within the primary care setting. J Clin Sleep Med 2013;9(7):681–686. DOI: 10.5664/jcsm.2838.
de Paula LKG, Alvim RO, Pedrosa RP, et al. Heritability of OSA in a Rural Population. Chest 2016;149(1):92–97. DOI: 10.1378/chest.15-0843.
Gjevre JA, Pahwa P, Karunanayake CP, et al. Excessive daytime sleepiness among rural residents in Saskatchewan. Can Respir J 2014;21(4):227–233. DOI: 10.1155/2014/921541.
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. DOI: 10.1007/s11325-013-0896-2.
Young T, Finn L, Austin D, et al. Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med 2003;167(9):1181–1185. DOI: 10.1164/rccm.200209-1055OC.