Age Group with Highest Prevalence of Moderate-to-Severe OSA
Based on the American College of Physicians guideline data, the age group older than 65 years (Option B) has the highest prevalence of moderate-to-severe obstructive sleep apnea.
Evidence from Population Studies
The guideline evidence demonstrates a clear age-related increase in OSA prevalence across multiple cohorts 1:
Key Age-Stratified Data
Older than 65 years group:
- Sforza 2011 study: 57% prevalence of moderate-to-severe OSA (AHI ≥15) in participants aged 65.6 ±0.8 years from a general French population 1
- Mean age 67.7 ±11.8 years cohort: 75% had OSA (AHI ≥5) 1
- Age 65 ±12 years cohort with chronic kidney disease: 39% had moderate-to-severe OSA (ODI ≥15) 1
55-64 years group (Option D):
- Subramanian 2011: Mean age 55 ±14 years with 85% OSA prevalence (RDI ≥5), but this includes mild cases 1
- Enciso 2011: Mean age 54.9 ±12.1 years with 63% having moderate-to-severe OSA (RDI ≥15) 1
45-54 years group (Option A):
- Kopitovic 2011: Median age 53 years with 62% OSA prevalence (AHI ≥5) 1
- Morrell 2012: Mean age 50.4 years with 84% having moderate-to-severe OSA (AHI ≥15), though this was a Wisconsin state employee cohort with selection bias 1
35-44 years group (Option C):
- Sareli 2011: Mean age 43.8 ±10.9 years with 77% OSA prevalence, but this was a bariatric surgery population with severe obesity (BMI 49.5) 1
- Ravesloot 2012: Mean age 43.0 ±10.0 years bariatric candidates with 72% moderate-to-severe OSA 1
25-34 years group (Option E):
- Thurtell 2011: Median age 32 years with 60% OSA prevalence, but this was an idiopathic intracranial hypertension population 1
Supporting Research Evidence
The prevalence of moderate-to-severe OSA increases progressively with age, with the highest rates in those over 65 years 2:
- Age 18-45 years: 33.2% OSA frequency (AHI >15)
- Age 46-65 years: 45.8% OSA frequency
- Age >65 years: 50.3% OSA frequency 2
The odds ratio of having OSA is three times higher at age >65 compared to younger adults (OR: 3.32,95% CI 2.29-4.88, p <0.001) 2.
Important Clinical Caveat
Elderly patients with OSA paradoxically report fewer symptoms despite higher disease severity 2. The >65 age group had significantly lower Epworth Sleepiness Scale scores (ESS: 6.0) compared to younger groups, despite having the highest OSA prevalence 2. This limited symptom perception in elderly patients makes early identification challenging but critically important for proper management 2.
Aging itself is an independent risk factor for severe OSA in elderly patients, even when they remain physically active and neuropsychiatrically unimpaired 3. Male sex, BMI, and aging are independent risk factors for severe OSA in the elderly population 3.