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One in three Singaporeans have moderate to severe sleep apnea and one in 10 Singaporeans suffer from severe sleep apnea: Study

17 Mar 2016

The Chinese and Malays have higher rates of obstructive sleep apnea compared to Indians.

A study funded by the JurongHealth Services Research and Quality Improvement Grant found that there is a high prevalence of a sleep disorder, known as obstructive sleep apnea (OSA), among the general population in Singapore. One in three Singaporeans have moderate-to-severe OSA and up to one in 10 Singaporeans suffers from severe sleep apnea. 

Despite the prevalence of OSA among Singaporeans, the condition is often underdiagnosed, as up to 90% of moderate-to-severe sleep apnea subjects in this study were previously undiagnosed. 

In particular, the prevalence of OSA varies across the three major ethnic groups of Chinese, Malays and Indians. The study found that Chinese and Malays had higher rates of OSA compared to Indians and the estimated population prevalence of moderate-to-severe OSA for Chinese and Malays were 32.1% and 33.8% respectively, and only 16.5% for Indians. 

Principal investigator, Dr Adeline Tan, Consultant, Respiratory Medicine, Ng Teng Fong General Hospital (JurongHealth) shares, “Obesity is one of the risk factors for OSA.  Interestingly, the study showed that the Chinese have high OSA rates among the three major ethnic groups even though they have the lowest obesity rates.  This study, done in the local context, collaborates with previous studies performed in the West, which also found that Chinese appear to be more at risk.” Dr Tan adds that craniofacial structure is one of the key determinants of predisposition to OSA, and the Chinese have been shown to have more severe craniofacial restriction as compared to caucasians in previous studies.

Published in the international Respirology journal this month, the study not only provided an update of OSA prevalence in Asians, its findings on OSA prevalence based on ethnicity, can also lead to better targeted public education, awareness, diagnosis and treatment of OSA among the different ethnic groups.

Impact on patients and the importance of awareness

OSA is characterised by repeated collapse of the airway during sleep leading to low oxygen levels and arousals, and is associated with excessive daytime sleepiness, poor job and academic performance, increased risk of road traffic accidents and heart problems such as hypertension and heart failure. Loud snoring that disrupts sleep is one of the most common symptoms of OSA, and can be accompanied by gasping and choking during sleep. OSA sufferers often report issues with memory, decision-making, depression and poor concentration while they are awake.

OSA can be evaluated based on signs and symptoms at primary care providers such as polyclinics and general practitioners, and cases can be referred to a sleep specialist for further evaluation. “Apart from relying on physical examinations and symptoms, we can conduct specialised tests at our Sleep Lab, which may involve overnight monitoring of breathing and other body functions as you sleep”, says Dr Tan. “The patient’s heart, lung, and brain activity, breathing patterns, and blood oxygen levels are monitored while asleep, and the test results can be used to accurately diagnosed OSA and prescribe the appropriate treatment.”

“The high prevalence rate of OSA among Singaporeans is worrying and there is a sizeable proportion of the population who are suffering from severe sleep apnea and unaware of their diagnosis,” says Dr Tan, “This could be due to low awareness of OSA. The public needs to know the signs of OSA so that they or their loved ones know when to seek medical help.”

Media Contacts:

Mr Aaron Loh
Manager, Communications
Ng Teng Fong General Hospital and Jurong Community Hospital (JurongHealth)
DID: 6716 5845   HP: 9682 1117

About Jurong Health Services
Jurong Health Services (JurongHealth) is Singapore's public healthcare cluster formed to facilitate the integration of services and care processes for the community in the west.

JurongHealth is managing the new integrated healthcare hub comprising the 700-bed Ng Teng Fong General Hospital and 400-bed Jurong Community Hospital to provide holistic care for patients. The two new hospitals are an integral part of the Jurong Lake District Masterplan. JurongHealth is also managing Jurong Medical Centre, a one-stop healthcare centre providing a range of specialist services and community health support services for residents in the west.

Annex A: Understanding Obstructive Sleep Apnea 

What is sleep apnea?
Sleep apnea is a serious sleep disorder that affects a person’s breathing and interrupts sleep. People with sleep apnea stop breathing repeatedly, sometimes hundreds of times, when they sleep.

There are two type of sleep apnea: obstructive and central.

Obstructive sleep apnea (OSA) is more common and causes a complete or partial upper airway blockage at sleep. In OSA, the diaphragm and chest muscles work extra hard to open the airway, causing breathing to resume with a loud gasp or body jerk. People with OSA rarely have a sound sleep as oxygen flow to vital organs is reduced and can cause them to experience irregularities in heart rhythm.

What are the symptoms of sleep apnea?

  • Daytime sleepiness or fatigue
  • Dry mouth or sore throat upon awakening
  • Frequent urination at night
  • Headaches upon waking
  • Intellectual impairment, such as trouble concentrating
  • Night sweats
  • Restlessness at sleep
  • Sexual dysfunction
  • Snoring
  • Sudden awakening with gasping or choking, forgetfulness or irritability

What are the effects of sleep apnea?

A number of heart problems have been associated with untreated sleep apnea, such as hypertension, stroke, arrhythmias, cardiomyopathy (enlargement of the muscle tissue of the heart), heart failure, diabetes, heart attacks, depression and sudden death.

Untreated sleep apnea is also linked to poor job and academic performance, work and road accidents.