Abstract
Background: The prevalence of obstructive sleep apnea (OSA) has not been assessed within the United States (US) in over adecade.
 Objectives:From 2013 to 2016, we calculated annual 2-year limited duration prevalence of diagnosed OSA in a large (~66million), geographically diverse insured population. We evaluated trends by age and sex; and assessed positive airway pressure (PAP) use and excessive sleepiness (hypersomnia diagnosis, or prescriptions for stimulant or wake-promoting agent [WPA]).
 Methods:Overall and age/sex specific prevalence per 100 insured persons was calculated on an annual basis. The cohort was defined to include those with medical and pharmacy claims activity. To mitigate rule-out diagnoses,cases had to have ≥2 medical claims for OSA within a 6-month period. Overall annual prevalences were directly standardized to the US population using 2016 US age and sex Census weights.
 Results: Annualage/sex adjusted prevalence of OSA increased from 2.4% in 2013 to 3.4% in 2016. OSA patients had a mean age of 58 years and there was a ≈2:1 male:female prevalence ratio. OSA patients with PAP claims increased from 42.2% to 44.1% over the study period. Excessive sleepiness (hypersomnia or stimulant/WPA prescriptions) for patients with or without PAP use both declined by ≈ 4% -5%.
 Conclusions:Diagnosed OSA prevalence and PAP use among insured members with claims activity increased during 2013-2016 while clinical markers of excessive sleepiness declined. Males had a much higher prevalence of OSA than females.
Highlights
Obstructive sleep apnea (OSA) is a chronic sleep disorder, closely linked with increasing age and obesity
Patient claims in the eligible cohort were queried using the International Classification of Diseases (ICD) 9 and/or 10 codes for obstructive sleep apnea (OSA), hypersomnia, and other diagnoses of interest, the Healthcare Common Procedure Coding System (HCPCS) codes for OSA treatments, and the National Drug Code (NDC) directory codes for wakepromoting agents (WPA)/stimulant prescription therapies
From year-to-year, approximately 60% of the eligible population was female, >27% were aged >65 years, the majority (>63%) had commercial insurance, and 40% were from the Southern census region; the largest region in the United States (US) (Table 1)
Summary
Obstructive sleep apnea (OSA) is a chronic sleep disorder, closely linked with increasing age and obesity. As the population of the United States (US) ages and obesity becomes more common, awareness has increased, with emphasis on better screening for and diagnosis of this disease 1,2,3. A review from 2008 estimated a 25% prevalence worldwide in women and a 4-7% prevalence worldwide in men, using data from studies between 1993-2004 1 3. 15 A systematic review of 24 studies assessing OSA prevalence in different areas of the world (including North America, Europe, and Asia) from the 1980s to the 2010s, found the reported prevalence in the general adult population ranged from 6%-17%, and as high as 49% in elderly populations. The prevalence of obstructive sleep apnea (OSA) has not been assessed within the United States (US) in over a decade
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