Population-based epidemiologic studies have uncovered the high prevalence and wide severity spectrum of undiagnosed
obstructive sleep apnea, and have consistently found that even mild
obstructive sleep apnea is associated with significant morbidity. Evidence from methodologically strong cohort studies indicates that undiagnosed
obstructive sleep apnea, with or without symptoms, is independently associated with increased likelihood of
hypertension,
cardiovascular disease,
stroke,
daytime sleepiness, motor vehicle accidents, and diminished quality of life. Strategies to decrease the high prevalence and associated morbidity of
obstructive sleep apnea are critically needed. The reduction or elimination of risk factors through public health initiatives with clinical support holds promise. Potentially modifiable risk factors considered in this review include
overweight and
obesity, alcohol, smoking, nasal congestion, and
estrogen depletion in menopause. Data suggest that
obstructive sleep apnea is associated with all these factors, but at present the only intervention strategy supported with adequate evidence is
weight loss. A focus on weight control is especially important given the expanding epidemic of
overweight and
obesity in the United States. Primary care providers will be central to clinical approaches for addressing the burden and the development of cost-effective case-finding strategies and feasible treatment for mild
obstructive sleep apnea warrants high priority.