Study Objectives

Emerging evidence indicates that Indigenous peoples experience disproportionately high rates of obstructive sleep apnea (OSA). This systematic review aimed to examine OSA prevalence, contributing factors, and intervention or treatment outcomes among Indigenous peoples worldwide.

Methods

We systematically searched PubMed, Embase, CINAHL, Cochrane CENTRAL, ATSI Health, Web of Science and PsycINFO (last searched 30 June, 2025), and grey literature for original research involving Indigenous peoples (≥18 years) diagnosed with OSA via self-report or laboratory-based measures (e.g., polysomnography). Data extraction focused on study characteristics and key findings. Methodological quality was assessed using NIH tools, and cultural appropriateness was evaluated using the CREATE Aboriginal and Torres Strait Islander Quality Appraisal Tool. A narrative synthesis was conducted.

Results

From 599 records, 41 studies from six countries were included. OSA prevalence among Indigenous populations varied widely (community-based samples, 6.5%-69%; referred samples, 85-95%; self-reported diagnosis, 1.2%-8.4%; hospital audit diagnoses, 0.8-11.4%), with only one study reporting a robust population-based estimate (~6.5% among Māori). Severe cases predominated in referred samples. Factors associated with OSA included male sex, age, BMI, neck circumference, craniofacial and geographic factors, and symptoms such as snoring. Treatment evidence was limited to CPAP, with low adherence.

Conclusions

Findings suggests that OSA is common among Indigenous peoples across diverse settings. However, prevalence estimates are heterogeneous and limited by differences in study design, sampling frame, and diagnostic approaches, with most evidence based on referred clinical samples. Improving awareness and culturally responsive screening and management may improve outcomes. Sleep health among Indigenous peoples warrants a higher priority in research, policy and practice.

Registration

The protocol for this systematic review was registered with Prospero (CRD42024466932).

Background

OSA is associated with significant morbidity in pregnancy. Minimal guidance is available on how best to screen, diagnose, treat, and re-evaluate for OSA in pregnant patients. Considering the potentially adverse consequences of OSA in pregnancy if left untreated, we assembled a panel of experts to review the available literature methodologically and make evidence-based recommendations.

Methods

Rigorous methodology was applied to provide a trustworthy evidence-based guideline and expert panel report. Panelists developed key clinical questions using the population, intervention, comparator, and outcome (PICO) format, addressing specific topics in OSA in pregnant individuals. MEDLINE (via PubMed) and the Cochrane Library were searched systematically for relevant literature and were supplemented by manual searches. References were screened with study evaluation tools to assess for inclusion, to extract meaningful data, and to grade the level of evidence to support each recommendation or suggestion.

Results

PICO questions related to screening, diagnosis, treatment, and follow-up of OSA in pregnant patients resulted in 9 conditional recommendations made with the evidence available and with the consensus of the expert panel. We recommend screening pregnant patients for OSA, either with a pregnancy-specific screening questionnaire or a standard tool. For those at risk of OSA based on screening, either a home sleep test or in-laboratory polysomnography is recommended for diagnosis. We recommend treatment for those with an apnea-hypopnea index (AHI) of 5 to 15 who have symptoms and sequelae or comorbidities, or those with an AHI of ≥ 15 regardless of symptoms or comorbidities, preferably with autotitrating positive airway pressure. Additionally, scheduled naps may be beneficial as an initial step in alleviating residual symptoms. Reassessment of OSA in the postpartum period is recommended in some patients.

Interpretation

Because of the low level of certainty, 9 conditional recommendations were made for the screening, testing, and treatment of OSA in pregnancy.

Objective

To explore the relationship between different definitions of objectively measured supine sleep position during late pregnancy and customised birthweight centile, as a marker of fetal wellbeing.

Design

Prospective cohort study.

Setting

Australian public hospital antenatal clinic.

Population

Eighty-four pregnant women from 32–36 weeks of gestation.

Methods

Body position was measured in degrees of roll using a tri-axial accelerometer worn around the abdomen for seven sequential nights. Supine was defined as ‘broad supine’ (0° = fully supine to 45° left/right tilt), and ‘supine low-tilt’ (0°–15°). Two additional Risk Indices capturing risk proportional to duration spent in each degree of supine-to-lateral tilt were developed. Birthweights were converted into customised centiles using GROW software.

Main Outcome Measures

The primary outcome was customised birthweight centile. Secondary outcomes included birthweight, gestational age at delivery, and fetal growth trajectory.

Results

Across 556 nights of data, the median nightly duration of broad supine positioning was 65.9 [25.0, 125.7] minutes compared to only 9.1 [0.7, 24.4] minutes of supine low-tilt. There was no relationship between customised birthweight centile and time spent in broad supine (R2 = 0.0027, F(1,82) = 0.22, p = 0.64) or supine low-tilt (R2 = 0.0029, F(1,82) = 0.24, p = 0.63); nor with any supine risk index and customised birthweight centile, birthweight, gestational age at delivery, or fetal growth trajectory.

Conclusion

In this cohort, there was no evidence of an association between objectively measured supine sleep and customised birthweight centile. Yet to be identified mechanisms unrelated to fetal growth may be responsible for supine going-to-sleep position being a risk factor for late stillbirth. Further prospective investigation is needed to untangle cause and effect; however, given the low rate of stillbirth, such a study may not be feasible.

Some mornings when you wake up, your head is fuzzy, your body is heavy, and you don’t feel rested. It felt like you were dreaming all night.

But did all that dreaming actually wear you out? Let’s look at what the science says.

Some mornings, you wake up and the dream is right there. Clear and vivid. You might still feel the emotion in your chest, and it can take a few minutes to remember where you are and what was real.

Other mornings, you open your eyes and there is nothing. Just a quiet sense of having slept.

You might know people who think they do not dream. However, the reality is we all do. Sometimes we have many in one night.

What varies is whether people remember their dreams and how often they remember them.