Global Risk Factor Evaluation of Obstructive Sleep Apnea in Relation to Research Activity and Socioeconomic Factors.

David A Groneberg,Rebekka K Seeger-Zybok,Doris Klingelhöfer

doi:10.3390/ijerph17186785

David A Groneberg, Rebekka K Seeger-Zybok + Show 1 more

Open Access

https://doi.org/10.3390/ijerph17186785

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Abstract

Obstructive Sleep Apnea is emerging as a global health epidemic, particularly due to the obesity pandemic. However, comprehensive prevalence data are still lacking and global OSA research has not yet been structurally evaluated. Using the latest comprehensive age/gender-specific BMI and obesity data, a global landscape estimating the risk/burden of OSA was created. Results were presented in relation to an in-depth analysis of OSA research and countries’ socioeconomic/scientific background. While the USA, Canada, and Japan are the highest publishing countries on OSA, Iceland, Greece, and Israel appeared at the forefront when relating the scientific output to socioeconomic parameters. Conversely, China, India, and Russia showed relatively low performances in these relations. Analysis of the estimated population at risk (EPR) of OSA showed the USA, China, India, and Brazil as the leading countries. Although the EPR and OSA research correlated strongly, major regional discrepancies between the estimated demand and actual research performances were identified, mainly in, but not limited to, developing nations. Our study highlights regional challenges/imbalances in the global activity on OSA and allows targeted measures to mitigate the burden of undiagnosed/untreated OSA. Furthermore, the inclusion of disadvantaged countries in international collaborations could stimulate local research efforts and provide valuable insights into the regional epidemiology of OSA.

Highlights

Obstructive sleep apnea (OSA) is the most common entity among sleep-related breathing disorders [1]
From 1991 onwards, the output of publications increased exponentially from 186 to 2626 in 2018. This trend was paralleled by an upswing of international collaboration articles (ICA) and the citation count
This so-called cited half-life (CHL) is a measure of citation survival reflecting the number of years, going back from the current year, that cover 50% of the citations in the present issue of the journal [31,32]

Summary

Introduction

Obstructive sleep apnea (OSA) is the most common entity among sleep-related breathing disorders [1]. Repetitive periods of pharyngeal collapse during sleep lead to intermittent disruptions of gas exchange and result in hypoxia and hypercapnia, causing reactive respiratory effort-related arousals, fragmented sleep, nocturnal sympathetic nervous system activation, elevated markers of oxidative stress, and inflammation [5,6]. This contributes to an increased risk of, e.g., cardiovascular, metabolic, and neurocognitive morbidities [2,7,8], and in the case of severe untreated OSA, to an elevated all-cause mortality independent of other risk factors [9].

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