Jason Dean-Chen Yin

BACKGROUND AND OBJECTIVE: Limited data exist on the prevalence variation in sleep-disordered breathing (SDB) across different Asian ethnicities. This population study aimed to estimate the prevalence of SDB in Singapore, a multiethnic nation, and to quantify the prevalence variation among Chinese, Malays and Indians. METHODS: The Singapore Health Study 2012 was a cross-sectional population study conducted on adults aged 21-79 years. Among 2329 participants who completed baseline examination, a sample of 242 subjects completed home-based sleep testing with an Embletta device (type 3 monitor). Moderate-to-severe SDB, defined as an apnoea-hypopnoea index (AHI) of ≥15 events/h, was used to estimate prevalence. RESULTS: The weighted estimates of the population prevalence of moderate-to-severe SDB and sleep apnoea syndrome were 30.5% and 18.1%, respectively. Of subjects with AHI ≥15, 91.0% were previously undiagnosed. Moderate-to-severe SDB prevalence varied across the Chinese (32.1%), Malays (33.8%) and Indians (16.5%). The mean body mass index (BMI) was lowest in Chinese (23.3 kg/m(2) ) and highest among Malays (26.0 kg/m(2) ) and Indians (25.4 kg/m(2) ). Compared with Chinese, Indians had lower odds of moderate-to-severe SDB after adjustment for age, sex and BMI (odds ratio 0.82, 95% CI: 0.70-0.96, P = 0.02). CONCLUSION: Sleep-disordered breathing is prevalent but mostly undiagnosed among Asians in Singapore. There was a lower prevalence of SDB among Indians compared with Chinese that remained after adjustment for age, sex and BMI. Strategies are needed to optimize diagnosis and recognize ethnic differences in SDB prevalence.

Universal health coverage (UHC) has been identified as a priority for international development by the G20, the World Health Organization, and the United Nations General Assembly. Since it was explicitly incorporated into the sustainable development goals (SDGs) as target 3.8, much effort has been expended on promoting UHC. Here we focus on four areas that, on current trajectories, are unlikely to achieve sufficient progress to meet the target. These are also areas for which G20 can provide substantial leverage: the principle of “leaving no one behind,” particularly in migrant health and genuine support for primary care; reliable domestic financing, which requires enlightened leadership and deliberate dialogue between finance and health sectors; harnessing and regulating medical and technological innovation; and mutual learning and harmonised aid among donor countries. We call on G20 leaders, who will meet in Osaka in June 2019, to take concrete action on these issues.
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\nThis article is based on a policy brief prepared by a working group convened by the Government of Japan as host of the Think 20 summit in Tokyo in May 2019.1 Our work has received input from a wide ranging global group of thought leaders, some of whom represent civil society, including patients and the general public.