A Systematic Review of Obstructive Sleep Apnea in Indigenous and First Nations Peoples Worldwide

Shannon Edmed; Daniel P Sullivan; Michelle Olaithe; Scott Coussens; Philip Terrill; Dwayne Mann; Danielle Wilson; Wayne Williams; Danny J Eckert; Sheethal Kalmadka; Sylistah Gadam; Yaqoot Fatima

doi:10.1093/sleepadvances/zpag080

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A Systematic Review of Obstructive Sleep Apnea in Indigenous and First Nations Peoples Worldwide

Journal article

Open access

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A Systematic Review of Obstructive Sleep Apnea in Indigenous and First Nations Peoples Worldwide

Shannon Edmed, Daniel P Sullivan, Michelle Olaithe, Scott Coussens, Philip Terrill, Dwayne Mann, Danielle Wilson, Wayne Williams, Danny J Eckert, Sheethal Kalmadka, …

Sleep Advances, Vol.Advanced access

23-Jul-2026

DOI: https://doi.org/10.1093/sleepadvances/zpag080

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Abstract

Sleep Apnea

Obstructive

Indigenous Peoples

Health Services Accessibility

Continuous Positive Airway Pressure

Health Disparities

First Nations

Aboriginal and Torres Strait Islander

Māori

Native American/Alaska Native

Sleep health equity

culturally responsive care

CPAP adherence

Systematic review

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).

Details

Title: A Systematic Review of Obstructive Sleep Apnea in Indigenous and First Nations Peoples Worldwide
Authors: Shannon Edmed (Corresponding Author) - The University of Queensland
Daniel P Sullivan - Griffith University
Michelle Olaithe - The University of Western Australia
Scott Coussens - Women's and Children's Health Network
Philip Terrill - The University of Queensland
Dwayne Mann - The University of Queensland
Danielle Wilson - University of the Sunshine Coast
Wayne Williams - University of the Sunshine Coast
Danny J Eckert - Adelaide Institute for Sleep Health
Sheethal Kalmadka - University of the Sunshine Coast
Sylistah Gadam - ARC Centre of Excellence for Children and Families over the Life Course
Yaqoot Fatima - University of the Sunshine Coast
Publication details: Sleep Advances, Vol.Advanced access
Publisher: Oxford University Press
DOI: 10.1093/sleepadvances/zpag080
ISSN: 2632-5012
Copyright note: © The Author(s) 2026. Published by Oxford University Press on behalf of Sleep Research Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Data Availability: All data were derived from published studies identified in the review, and no new individual participant data were collected.
Grants: ARC Centre of Excellence for Children and Families over the Life Course, CE200100025, Australian Research Council (Australia, Canberra) - ARC
Obstructive sleep apnoea diagnosis and management in First Nations communities: community co-design, local capacity building and place-based models for sustainable success, MRF2022971, Department of Health and Aged Care (Australia, Canberra)
Novel approaches for targeted sleep apnoea treatment and management, 1196261, National Health and Medical Research Council (Australia, Canberra) - NHMRC
Organisation Unit: Indigenous and Transcultural Research Centre; Thompson Institute
Language: English
Record Identifier: 991247170602621
Output Type: Journal article

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