Incidence, Characteristics, and Management Pathways of Obstructive Sleep Apnea in England: A 10-Year Retrospective Cohort Study.

BACKGROUND

OSA is common and can be effectively treated with CPAP. Up-to-date English epidemiologic data to inform care are scarce.

RESEARCH QUESTION: What are the incidence of OSA, patient characteristics, comorbidities, diagnostic methods, treatment pathways, and waiting times in England?

STUDY DESIGN AND

METHODS

This retrospective cohort study used the Clinical Practice Research Datalink and linked Hospital Episode Statistics databases from January 1, 2010, to December 30, 2020. Included adults had ≥ 1 OSA code and ≥ 12 months' medical records before/after OSA diagnosis. Participant subgroups were defined by age and diagnosis/treatment (OSA + CPAP, OSA without CPAP, and no OSA). The OSA incidence was determined, and baseline sociodemographic characteristics/comorbidities, diagnosis/treatment pathways, and patient waiting times were recorded. The primary analysis population included data from 2010 to 2019 (to exclude the health effects of the COVID-19 pandemic); sensitivity analysis determined the OSA incidence rate for the full data set.

RESULTS

The primary analysis population included 69,155 individuals (nearly 70% male; mean age, 53.4 ± 13.2 years; mean BMI, 36.0 ± 8.5 kg/m2; median follow-up, 45 months); there were 13,058, 16,068, and 40,029 in the OSA + CPAP, OSA without CPAP, and no OSA groups, respectively. Obesity and cardiometabolic disorders were the most common comorbidities. The incidence of OSA increased from 46.74 per 100,000 in 2010 to 91.04 per 100,000 in 2019, with an average of 65.06 per 100,000 person-years over the period. Median waiting times were 37 days from general practitioner referral to sleep clinic visit, 50 days from sleep clinic visit to OSA diagnosis, 70 days from diagnosis to CPAP initiation, and 194 days from general practitioner referral to CPAP initiation. These medians represent independent intervals and may not sum to the total journey time. Forty-two percent of patients had no follow-up sleep clinic visits after starting CPAP.

INTERPRETATION: These data highlight the increasing burden of OSA in England and underscore the need for improved diagnostic/treatment frameworks to expedite OSA management.