Elin Helga Thorarinsdottir, Bryndis Benediktsdottir, Thor Aspelund, Hjordis Sigrun Palsdottir, Sesselja Hreggvidsdottir, Tryggvi Leo Gudmundsson, Ali Reza Matin, Bjorg Eysteinsdottir, Christer Janson, Eva Lindberg, James Potts, Andre Fs Amaral, Thorarinn Gislason
Most adults accepted OSA screening when offered. Among those with moderate-to-severe OSA identified through population screening, most accepted evaluation and PAP treatment, with approximately half becoming long-term users. These findings suggest that population-based detection of OSA followed by routine clinical management is feasible. Future studies should identify subgroups most likely to benefit and evaluate alternative treatment strategies.
OBJECTIVES: To estimate uptake of obstructive sleep apnoea (OSA) screening and initiation and long-term use of positive airway pressure (PAP) treatment in a middle-aged and older general population cohort.
DESIGN: Prospective population-based cohort study.
SETTING: Icelandic arm of the multinational Burden of Obstructive Lung Disease follow-up study II (2019-2021) PARTICIPANTS: 378 non-institutionalised adults aged 54-91 years were invited from a general population cohort. 26 with prior OSA diagnosis were excluded. Of the remaining participants, 334 (88.4%) completed a technically adequate home sleep apnoea test.
INTERVENTIONS: Those with an apnoea-hypopnoea index (AHI)≥15 events/hour were invited for clinical evaluation and when appropriate, referred for PAP treatment. Adherence was assessed 2 years after PAP initiation.
MAIN OUTCOME MEASURES: Primary outcomes were screening uptake and PAP initiation. Secondary outcomes included long-term PAP use and objective adherence 2 years after referral.
RESULTS: AHI≥15 was identified in 132/334 participants (39.5%). Of these, 123 (93.2%) attended clinical evaluation and 99 (75.0%) were referred for PAP treatment. Of those not referred, six declined PAP and the remainder were advised alternative management or reassessment. At 2-year follow-up, 53/99 (53.5%) were long-term PAP users, 43/99 (43.4%) had discontinued and 3/99 (3.0%) never initiated PAP. Objective adherence data were available for 47/53 long-term users; 21/47 (44.7%) met adherence criteria (≥4 hours/night on ≥70% of nights in the preceding 30 days).
CONCLUSIONS: Most adults accepted OSA screening when offered. Among those with moderate-to-severe OSA identified through population screening, most accepted evaluation and PAP treatment, with approximately half becoming long-term users. These findings suggest that population-based detection of OSA followed by routine clinical management is feasible. Future studies should identify subgroups most likely to benefit and evaluate alternative treatment strategies.