Screening for obstructive sleep apnoea in the general population in Iceland and uptake of positive airway pressure treatment: a prospective cohort study
File(s)
Accepted version
Supporting information
Author(s)
Thorarinsdottir, Elin
Benediktsdóttir, Bryndis
Aspelund, Thor
Palsdottir, Hjordis
Hreggvidsdottir, Sesselja
Type
Journal Article
Abstract
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 to 91 years were invited from a general population cohort. Twenty-six with prior OSA diagnosis were excluded. Of the remaining participants, 334 (88.4%) completed a technically adequate home sleep apnoea test (HSAT).
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 two 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 two 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 two-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.
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 to 91 years were invited from a general population cohort. Twenty-six with prior OSA diagnosis were excluded. Of the remaining participants, 334 (88.4%) completed a technically adequate home sleep apnoea test (HSAT).
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 two 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 two 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 two-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.
Date Issued
2026-09-02
Date Acceptance
2026-06-30
Citation
BMJ Open, 2026
ISSN
2044-6055
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open
Copyright Statement
Copyright This paper is embargoed until publication. Once published the author’s accepted manuscript will be made available under a CC-BY License in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy).
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Publication Status
Accepted