Managing obstructive sleep apnoea and achieving equity: implications for health services

Sleep occupies a third of life, and poor sleep has wide-ranging consequences for health, safety, and well-being. Recent research suggests significant inequalities in sleep health between Māori and non-Māori adults in New Zealand including self-reported sleeping problems and obstructive sleep apnoea syndrome (OSAS). This paper will outline a series of studies that were designed to assess how many people were affected by OSAS in Aotearoa/New Zealand and specifically sought to prioritise the needs of Māori. It will discuss a number of issues related to the diagnosis and treatment of OSAS in New Zealand and present strategies for reducing inequalities in sleep health.

Obstructive sleep apnea in New Zealand adults: prevalence and risk factors among Māori and non-Māori

STUDY OBJECTIVES

Examine the distribution of symptoms and risk factors, and estimate the prevalence of obstructive sleep apnea (OSA) among Māori and non-Māori New Zealanders.

DESIGN

Mail-out survey to a stratified random sample from the electoral roll of 10,000 people aged 30-59 y, and overnight MESAM IV monitoring during sleep of a similarly aged stratified random sample of 364 people from the Wellington electoral roll.

SETTING

Nationwide survey of OSA symptoms (71% response rate) and regional home-based measurement of respiratory disturbance index (RDI, 4% oxygen desaturations/h of sleep, plus bursts of snoring or > or = 10/min increase in heart rate).

PARTICIPANTS

Sample designs aimed for equal numbers of Māori and non-Māori participants, men and women, and participants in each decade of age.

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

Māori were more likely than non-Māori to report OSAS risk factors and symptoms. After controlling for sex and age, Māori were 4.3 times more likely to have RDI > or = 15 (95% CI = 1.3-13.9). Ethnicity was not an independent risk factor after controlling for body mass index (BMI) and neck circumference. The prevalence of OSAS (RDI > or = 5 and ESS > 10) was conservatively estimated to be 4.4% for Māori men, 4.1% for non-Māori men, 2.0% for Māori women, and 0.7% for non-Māori women.

CONCLUSIONS

The national survey and the regional monitoring study indicate a higher prevalence of OSA among Māori and among men. The higher prevalence among Māori appears to be attributable to recognized risk factors, notably body habitus. In addition to increased prevention and treatment services, strategies are needed to reduce ethnic disparities in OSAS prevalence.