(1354) Under-Reporting of Sleep Symptoms Among U.S. Adults at High Risk for Obstructive Sleep Apnea

Introduction: Adults with obesity and nocturnal respiratory symptoms, such as snoring and gasping during sleep, are considered at risk for obstructive sleep apnea (OSA). Despite this elevated risk, many patients never discuss sleep problems with clinicians. This study assessed prevalence of reported sleep trouble and whether depressive symptoms or cardiometabolic comorbidities are associated with under-reporting.

Methods: Using 2017–March 2020 National Health and Nutrition Examination Survey data, adults ≥18 years with obesity (BMI ≥30 kg/m²) who reported snoring, snorting/gasping, or apneic events during sleep at least 3 nights per week were classified as high-risk for OSA. The primary outcome was never having told a provider about trouble sleeping. Covariates included age, sex, race/ethnicity, BMI, depressive symptoms, hypertension, and diabetes. Survey-weighted logistic regression estimated adjusted odds of never reporting sleep trouble.

Results: Among 299 high-risk adults, 32% had never discussed sleep symptoms with a clinician. Moderate-to-severe depressive symptoms were present in 21% and were associated with significantly lower odds of never reporting sleep trouble (aOR 0.19; 95% CI 0.06–0.65). Other cardiometabolic comorbidities were not clearly associated with under‑reporting.

Conclusions: Many adults with symptoms suggestive of OSA have never discussed sleep trouble with a clinician, indicating missed opportunities for diagnosis and intervention. Depressive symptoms were associated with increased reporting of sleep problems, suggesting that adults without depression may be more likely to remain undiagnosed. These findings highlight gaps in recognition of sleep disorders among adults at high-risk for OSA and support consideration of systematic assessment of sleep symptoms in clinical practice.