Health Fact Sheets
Sleep Apnea in Canada, 2016 and 2017

Release date: October 24, 2018

Sleep apnea is characterized by repetitive apneas during sleep. An apnea is the complete interruption of breath for at least 10 seconds. Previous studies have found sleep apnea is associated with cardiovascular, coronary artery disease and other cardiac related conditions, such as heart failure and cardiac arrhythmia.Note 1 Note 2 Other known associated diseases of sleep apnea include obesity, diabetes, and depression.Note 2 Note 3 Note 4 Sleep apnea affects both men and womenNote 3 Note 4 and has personal, social and economic impacts that affect our overall healthcare system.Note 2 Note 3 Note 4

The Canadian Health Measures Survey (CHMS) is a biennial survey that collects data on the health habits of Canadians through a household questionnaire and physical measures in a mobile examination centre. The 2016 and 2017 CHMS asked respondents about past diagnosis and treatment of sleep apnea. It also collected responses and physical measurements of several known risk factors for sleep apnea. The risk factors are based on the STOP-Bang Questionnaire, which is an acronym for Snoring, Tiredness, Observed apnea, blood Pressure, Body mass index, Age, Neck circumference and Gender.Note 5 Note 6 For more information on the STOP-Bang Questionnaire, see the “About the STOP-Bang Questionnaire” section.

In 2016 and 2017, 6.4% of Canadians reported they had been diagnosed by a health care professional with sleep apnea (Chart 1). This is higher than results from a 2009 survey which found that the prevalence of self-reported sleep apnea was only 3% among adults 18 years and older.Note 7

Self-reported sleep apnea differed by age and sex. Older adults (60 to 79 years) were three times as likely to report being diagnosed compared to their younger counterparts. Males were two times more likely to report being diagnosed compared with females. These trends were also found in the 2009 survey.Note 7

Chart 1

Data table for Chart 1
Data Table for Chart 1
Table summary
This table displays the results of Data Table for Chart 1 . The information is grouped by Age (appearing as row headers), Percent (appearing as column headers).
Age Percent
Overall 6.4
18 to 59
years
4.2
60 to 79
years
12.8Note *
Sex
Males 8.8
Females 4Note E: Use with caution Note *

Sleep apnea symptoms differ between males and females

Males and females tend to present different symptoms related to sleep apnea, which may partly explain the difference in diagnosis between the sexes.Note 1 Note 3 Note 4

Males tend to display more classical symptoms such as snoring or trouble breathing compared with females.Note 2 Note 3 Note 4 In 2016 and 2017, males (20%) were almost two times more likely to report snoring loud enough to be heard through closed doors compared with females (10%) (Chart 2). Males (9%) were three times more likely to report that someone had observed them stop breathing during sleep compared with females (3%). These results are similar to those in the U.S.Note 8

Chart 2

Data table for Chart 2
Data Table for Chart 2
Table summary
This table displays the results of Data Table for Chart 2 Males and Females, calculated using percent units of measure (appearing as column headers).
Males Females
percent
Snores loudly 19.6 10.4Note *
Observed to stop breathing 8.6 2.8Note E: Use with caution Note **
Tired 53.2 67.0Note **

By contrast, women tend to present symptoms such as fatigue or insomnia.Note 2 Note 3 Note 4 In 2016 and 2017, females were more likely than males to report that they often felt tired, fatigued or sleepy during the day time (Chart 2). Females were also more likely to report having trouble going to sleep or staying asleep sometimes, often or always (without the use of sleeping aids) (Chart 3).

Chart 3

Data table for Chart 3
Data Table for Chart 3
Table summary
This table displays the results of Data Table for Chart 3 Males and Females, calculated using percent units of measure (appearing as column headers).
Males Females
percent
Never 35.3 26.1Note *
Rarely 32.4 20.7Note *
Sometimes 19.9 25.6Note *
Often 8.2 16.6Note **
Always 4.2Note E: Use with caution 10.9Note E: Use with cautionNote *

Other factors, such as differences in fat distribution or upper airway anatomy may also be contributing to the difference in sleep apnea diagnosis between males and females.Note 1 Note 3 Note 4 Females were more than two times more likely than males to have a high body mass index (BMI of >35kg/m2) (Chart 4). By contrast, males were three times more likely to have a high neck circumference (≥17 inches for males or ≥16 inches for females).

Chart 4

Data table for Chart 4
Data Table for Chart 4
Table summary
This table displays the results of Data Table for Chart 4 Males and Females, calculated using percent units of measure (appearing as column headers).
Males Females
percent
High blood pressure 19.2 21.5
High BMI 5.1Note E: Use with caution 12.5Note **
High neck circumference 6.0Note E: Use with caution 2Note E: Use with cautionNote *

The varying presentation of symptoms between men and women underline a potential under-diagnosis of sleep apnea in women. This is problematic from a public health perspective because of the higher risk of cardiovascular disease and other diseases associated with sleep apnea.Note 3 Previous results showed that Canadian adults who reported being diagnosed with sleep apnea were more likely to report having other diseases such as diabetes, hypertension, heart disease, and mood disorders (e.g. depression).Note 7

One in four males at high risk for developing sleep apnea

In 2016 and 2017, nearly one-third (30%) of Canadian adults were considered to be at intermediate or high risk for sleep apnea based on the STOP-BANG tool—15% were high risk and 15% were moderate risk (Chart 5).

Chart 5

Data table for Chart 5
Data Table for Chart 5
Table summary
This table displays the results of Data Table for Chart 5 Low risk, Moderate risk and High risk, calculated using percent units of measure (appearing as column headers).
Low risk Moderate risk High risk
percent
Overall 70.5 14.6 14.9
18 to 39 91.5 Note F: too unreliable to be published 7.2
40 to 59 61.3 19.3 19.4
60 to 79 47.3 31.3 21.4
Males 58.5 17.0 24.6
Females 82.5 12.2 5.3Note E: Use with caution

Older adults (aged 40 to 79) were at an elevated risk of sleep apnea compared to their younger counterparts (aged 18 to 39) (Chart 5). One in five adults aged 40 to 59 was at high risk, and one quarter of older adults aged 60 to 79. Less than 10% of younger adults were at intermediate or high risk.

The overall risk of sleep apnea was higher in males compared with females. One in four males was considered high risk for sleep apnea, which was five times higher than females where one in twenty was considered high risk.

About the STOP-BANG

The STOP-BANG questionnaireNote 5 uses a series of questionsNote 9 and results of physical measurements to calculate the risk for sleep apnea in adults aged 18 and older.

Snoring – Do you snore loudly (loud enough to be heard through closed doors)?
Tired – Do you often feel tired, fatigued or sleepy during the daytime?
Observed – Has anyone observed you stop breathing or choking/gasping during your sleep?
Pressure – Do you have or are being treated for high blood pressure?
Body mass index (BMI) – Body mass index more than 35kg/m2?
Age – Age older than 50?
Neck circumference – Neck size 17 inches or larger for males or 16 inches or larger for females?
Gender – Male?Note 6

Positive answers to the above questions are then used to determine risk:
Low risk – Yes to 0 to 2 questions
Intermediate risk – Yes to 3 to 4 questions
High risk – Yes to 5 to 8 questions

  • OR yes to 2 or more of 4 STOP questions + male gender
  • OR yes to 2 or more of 4 STOP questions + BMI > 35kg/m2
  • OR yes to 2 or more of 4 STOP questions + neck circumference ≥ 17 inches for males or ≥ 16 inches for females

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