Prevalence and Risk Factors for Obstructive Sleep Apnea in São Paulo: Findings From the 4th Edition of the <scp>EPISONO</scp> Study

Obstructive sleep apnea (OSA) affects around 936 million individuals worldwide, making it the most prevalent breathing-related sleep disorder. The aim was to estimate the prevalence of OSA in São Paulo, Brazil, based on data from the São Paulo Epidemiologic Sleep Study (EPISONO) 4th edition. This was a cross-sectional study with a probabilistic sample obtained through a 4-stage cluster sampling method aiming to represent the population according to age (20-80 years), gender and socio-economic condition. Participants underwent in-lab full-night polysomnography and completed sleep-related questionnaires. The diagnosis of OSA followed the most recent guidelines of the American Academy of Sleep Medicine. Prevalences were calculated and a multivariable logistic regression evaluated risk factors associated with OSA. The total sample included 769 individuals (452 women). The general adjusted prevalence of OSA was 37.12%, being higher in men (44.88%) than women (30.79%). Greater prevalence was observed in advanced age groups. Moderate and severe OSA affected 11.5% and 7.9% of the participants, respectively. Ageing, body mass index and being male were associated with a higher risk of OSA, especially in moderate-to-severe cases. The 4th edition of EPISONO found that more than one-third of the population had OSA, reaching 45% in males. These results underscore the need for public health actions based on scalable prevention strategies and equitable access to OSA therapies.