Sleep and Breathing

, Volume 17, Issue 3, pp 967–973 | Cite as

High prevalence of undiagnosed obstructive sleep apnoea in the general population and methods for screening for representative controls

  • Laila SimpsonEmail author
  • David R. Hillman
  • Matthew N. Cooper
  • Kim L. Ward
  • Michael Hunter
  • Stewart Cullen
  • Alan James
  • Lyle J. Palmer
  • Sutapa Mukherjee
  • Peter Eastwood
Original Article



Undiagnosed obstructive sleep apnoea (OSA) in the community makes comparisons of OSA subjects with control samples from the general population problematic. This study aims to estimate undiagnosed moderate to severe OSA in a general population sample and to determine the capacity of questions from the Berlin questionnaire (BQ) to identify subjects without diagnosed OSA of this severity.


Using a general population sample (n = 793) with no history of OSA, case and control status for moderate–severe OSA was determined by home-based nasal flow and oximetry-derived apnoea–hypopnoea index using a cut-off value of ≥15 events/h to define cases. The diagnostic accuracy of the complete BQ and its component questions in identifying cases was assessed by calculating sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and post-test probabilities.


The age-standardised prevalence estimate of moderate–severe OSA was 9.1 % (12.4 % in men, 5.7 % in women). Sensitivity of the BQ in this population was 54 %, and specificity, 70 %. A combination of questions regarding snoring frequency and hypertension provided maximal post-test probability of OSA and greatest post-screen sample size.


Undiagnosed OSA is highly prevalent in the Western Australian general population. While the complete BQ is a sub-optimal screening instrument for the general population, snoring frequency or hypertension can be used to screen out moderate–severe OSA from general population samples with limited reduction in sample size. As there are few general population samples available for epidemiological or genetic studies of OSA and its associated phenotypes, these results may usefully inform future case–control studies.


Berlin Case–control OSA General population Portable monitoring Epidemiology 



The authors gratefully acknowledge Michelle Olaithe, Matthew Knuiman, Kashif Mukhtar and Mark Divitini, the Busselton community and the ResMed Science Center.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Laila Simpson
    • 1
    • 2
    • 3
    Email author
  • David R. Hillman
    • 3
    • 4
  • Matthew N. Cooper
    • 5
  • Kim L. Ward
    • 1
    • 3
    • 4
    • 6
  • Michael Hunter
    • 9
    • 6
  • Stewart Cullen
    • 3
    • 4
  • Alan James
    • 3
    • 4
    • 9
  • Lyle J. Palmer
    • 10
    • 11
  • Sutapa Mukherjee
    • 3
    • 7
    • 8
  • Peter Eastwood
    • 2
    • 3
    • 4
  1. 1.Centre for Genetic Epidemiology and BiostatisticsUniversity of Western AustraliaPerthAustralia
  2. 2.School of Anatomy and Human Biology, Faculty of Life and Physical SciencesThe University of Western AustraliaPerthAustralia
  3. 3.Western Australian Sleep Disorders Research InstituteSir Charles Gairdner HospitalPerthAustralia
  4. 4.Department of Pulmonary PhysiologySir Charles Gairdner HospitalPerthAustralia
  5. 5.Telethon Institute for Child Health Research, Centre for Child Health ResearchUniversity of Western AustraliaPerthAustralia
  6. 6.School of Population HealthUniversity of Western AustraliaPerthAustralia
  7. 7.Department of MedicineUniversity of TorontoTorontoCanada
  8. 8.Women’s College Research Institute/Women’s College HospitalTorontoCanada
  9. 9.Busselton Population Medical Research InstituteUniversity of Western AustraliaPerthAustralia
  10. 10.Genetic Epidemiology and Biostatistics PlatformOntario Institute for Cancer ResearchTorontoCanada
  11. 11.Samuel Lunenfeld Research InstituteUniversity of TorontoTorontoCanada

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