Choking in Sleep: Why Is the Disease Afflicting 176 Million Chinese Still Overlooked?

In 2021, unable to endure the distress of waking up gasping due to sleep apnea, 30-year-old Mr. Liu finally made the decision to seek medical attention.

Initially, he paid little attention to his thunderously loud snoring, even boasting that it was a sign of sound sleep. It was not until the condition progressively worsened—manifesting as frequent nocturnal awakenings due to severe sensations of suffocation, accompanied by profuse sweating, body jerks, and cardiac arrhythmia—that he became truly alarmed.

Under the arrangement of a pulmonologist, Mr. Liu underwent an overnight polysomnography (PSG) in the monitoring ward of the Sleep Respiratory Center. By continuously monitoring indicators such as nighttime respiration, arterial oxygen saturation, electroencephalogram (EEG), electrocardiogram (ECG), and heart rate, physicians can determine whether Mr. Liu experiences apnea, as well as the frequency and duration of apneic episodes, the lowest arterial oxygen saturation levels during these events, and the extent of their impact on his health. PSG is currently recognized internationally as the gold standard for diagnosing obstructive sleep apnea (OSA).

The following day, the PSG monitoring report was released, and Mr. Liu was diagnosed with severe sleep apnea—during more than 8 hours of sleep, he experienced over 400 apneic episodes, with the longest lasting 87 seconds!

What does 87 seconds mean? Let’s try this: in a static state, hold your breath. How long can you go without taking a breath?

This condition, which has been troubling Mr. Liu—namely, obstructive sleep apnea (OSA)—also affects 176 million people in China. Globally, more than 1 billion people suffer from sleep apnea, which disrupts their sleep, impairs health, and can even be life-threatening.

Although snoring is the predominant symptom among patients with obstructive sleep apnea (OSA), disease severity varies significantly between individuals. The number of apneic episodes can range from as few as 30 to several hundred per night, while the duration of each episode may last from ten-plus seconds to over two minutes in severe cases. Once asleep, OSA patients enter a repetitive cycle of breathing cessation followed by resumption. Mild cases primarily impair sleep quality, leading to daytime drowsiness and poor concentration; severe cases can precipitate comorbidities or complications, such as cardiovascular and cerebrovascular diseases (e.g., hypertension) and metabolic disorders (e.g., diabetes).

March 21 is World Sleep Day, designated by the WHO.By analyzing the domestic and international markets for sleep-disordered breathing, VCBeat has identified significant disparities between them. Abroad, numerous innovative companies specializing in the screening and management of sleep-disordered breathing have already achieved considerable scale and obtained FDA clearance. In contrast, China’s market for obstructive sleep apnea (OSA)—covering screening, monitoring, treatment assessment, and disease course management—remains in a relatively early stage, with most participants still refining their products and exploring business models. What accounts for this disparity? How substantial is the growth potential in this field? VCBeat provides an analysis below.

The 2019 report “Obstructive Sleep Apnea and the Global Economic Burden,” published in the internationally renowned medical journal The Lancet Respiratory Medicine, revealed that OSA affects the health of over 1 billion people worldwide. Among adults aged 30–69 years, there are 936 million cases of mild-to-moderate OSA and 425 million cases of moderate-to-severe OSA. China has the highest number of OSA patients globally, reaching 176 million.

According to the “Multidisciplinary Diagnosis and Treatment Guidelines for Adult Obstructive Sleep Apnea,” the prevalence of OSA is 2%–4%. It causes intermittent hypoxia, hypercapnia, and sleep architecture disruption, and can lead to multi-organ and multi-system damage, including hypertension, coronary heart disease, arrhythmias, cerebrovascular disease, cognitive impairment, and type 2 diabetes. Thus, it is evident thatOSA is a true systemic disease that causes extensive and severe health damage, warranting attention from the entire society.

Low awareness, low early diagnosis rates, and low adherence to standardized treatment characterize the current landscape of OSA diagnosis and management in China. Studies indicate that the early diagnosis rate for OSA remains below 1%, with the vast majority of individuals unaware of their condition. Furthermore, many patients who have been diagnosed fail to adhere to standardized and continuous treatment regimens.

Obstructive Sleep Apnea (OSA) is not only a common chronic disease in adults but also highly prevalent among children. The 2012 American Academy of Pediatrics guidelines reported a prevalence rate of 4.8% for pediatric OSA. Pediatric OSA is the most severe condition within the spectrum of sleep-disordered breathing in children. If not diagnosed promptly and managed effectively, it can significantly impair a child’s development, leading to a series of complications such as craniofacial abnormalities, behavioral disorders, learning disabilities, growth retardation, neurocognitive impairment, and endocrine and metabolic dysregulation. For children undergoing growth and development, failure to identify and treat OSA in a timely manner often results in irreversible physical and psychological developmental issues.

Orange FamilyDirector of StrategyWang WenjingIn the interviewindicated that OSAIt has not yet reached the stage of widespread adoption in China,DomesticEstablishmentSleepRespirationMonitoringClinical Institutions for Multidisciplinary Diagnosis and TreatmentQuantitythanLess,Currently, it is only being carried out in large tertiary hospitals in some major and medium-sized cities.PSGPolysomnography RequirementsPatientAn overnight hospital stay under the supervision of medical personnel is required, with monitoring devices attached to multiple sites including the head, nose, mouth, chest and abdomen, arms, and fingertips. Clinically, thisOSAScreening and diagnostic methods are constrained by factors such as privacy, comfort, and the limited number of rooms and equipment in sleep centers, making it difficult to conduct them on a large scale and with high efficiency.OSAScreening of。

Professor Wang Chen, an academician of the Chinese Academy of Engineering and President of China-Japan Friendship Hospital, has roughly divided the development of respiratory medicine in China into three stages: tuberculosis, pulmonary diseases, and pan-respiratory pulmonology. The first stage focused on the prevention and control of tuberculosis, primarily combating infectious pulmonary tuberculosis. The second stage, from the 1970s to the early 1990s, centered on the prevention and control of chronic obstructive pulmonary disease (COPD). The third stage, since the mid-1990s, has been characterized by the increasingly prominent integrated development of respiratory medicine and critical care medicine, marking the entry into an era of respiratory critical care and respiratory interventional procedures.

The developmental priorities at each stage were determined based on the prevailing social context and the urgency of the diseases themselves. Reviewing the more than 50-year development history of respiratory medicine in China, OSA does not align with the developmental priorities of the first three stages.However, with advancements in clinical medicine, China’s respiratory discipline is progressing toward a phase focused on chronic respiratory diseases and respiratory rehabilitation. As a significant chronic respiratory condition, obstructive sleep apnea (OSA) is receiving increasing attention and being addressed more effectively.

The 2018 “Multidisciplinary Diagnosis and Treatment Guidelines for Adult Obstructive Sleep Apnea” defines OSA as a sleep-related breathing disorder characterized primarily by snoring during sleep, apnea episodes, and daytime sleepiness. Prior to this, sleep apnea was classified as a “syndrome” (OSAS).

The term “syndrome” was removed from OSAS to emphasize that sleep apnea is now recognized as an independent disease with distinct etiology, pathology, clinical manifestations, and diagnostic and therapeutic approaches, rather than a collective term for a cluster of symptoms.. Given the precedent of hypertension and hyperglycemia transitioning from syndromes to chronic diseases, this shift is regarded by industry experts as a significant advancement in the clinical evolution of OSA. Furthermore, with advances in diagnostic and therapeutic technologies and heightened health awareness among the public, the external conditions for the development of OSA management are also maturing.

Accurate and timely diagnosis of sleep apnea is crucial for effective treatment. This demand has also attracted numerous innovative enterprises to enter the market, focusing their business on sleep monitoring and initial screening. However, through a review of these companies' development, VCBeat found that most are still in the angel or seed funding stages, with relatively slow growth.

According to VCBeat, “Chengyi Jiaren,” a renowned innovation and entrepreneurship enterprise based in the Binhai New Area of Tianjin, is among the very few companies that have successfully completed Series B financing. Since its establishment in 2014, Chengyi Jiaren has focused directly on the field of obstructive sleep apnea (OSA). From the development of portable screening devices to the construction of a respiratory sleep monitoring algorithm platform, Chengyi leverages its integrated software and hardware systems to generate AI-powered reports with graphical trend analysis. This enables intelligent assessment of patients’ continuous treatment efficacy, allowing physicians and family members to remotely guide patients in self-managed rehabilitation. After establishing capabilities in OSA screening, Chengyi expanded into personalized customization of OSA treatment modalities, such as ventilators and oral appliances. It also developed a targeted patient disease-course follow-up management system, gradually achieving an integrated service model encompassing initial OSA screening, home-based rehabilitative therapy, and personalized follow-up care.

Over the past seven years, Orange Family has grown into a leading high-tech enterprise in China, providing comprehensive digital sleep and respiratory health management services.In September 2021, the “Sleep Apnea Data Transmission and Processing Software,” independently developed by Chengyi Jiaren, obtained the medical device registration certificate from the National Medical Products Administration (NMPA)., by screening through sleep monitoring and providing services such as digital anti-snoring oral appliances and ventilator therapy, it further enhanced its existing channel network to cover more terminal markets including hospitals, dental clinics, and health examination centers, ultimately achieving a closed-loop service for the early screening, diagnosis, and treatment of OSA.

InWang Jianjun, COO of Zhaoguan TechnologyIt appears that capital has consistently focused on the sleep-disordered breathing market, given the large patient population in this field. However,Capital investors also place significant emphasis on whether a product has obtained medical certifications, the actual number of clinical applications deployed by the enterprise, and the product’s commercialization capabilities.

Zhaoguan Technology’s continuous blood oxygen saturation monitoring ring has entered the market with Class II medical device certification,It can monitor patients' blood oxygen and heart rate data throughout the night’s sleep, and assess the severity of sleep apnea in a home setting using indicators such as the Oxygen Desaturation Index (ODI), minimum blood oxygen saturation, and the duration spent at different oxygen saturation levels. This serves as a basis for determining the need for treatment and for evaluating post-treatment efficacy.

Wang Jianjun explained that the approval process for medical devices is lengthy, requiring company teams to demonstrate perseverance and focus, along with sustained R&D investment. Moreover, even after obtaining certification, a product’s accuracy and reliability must withstand rigorous testing through extensive real-world clinical applications. Otherwise, even with regulatory approval, if the product fails to meet actual clinical requirements in terms of accuracy and practicality, it will ultimately fail to gain acceptance from users and the market.

In developed countries such as the United States and Japan, sleep apnea has been included in the scope of chronic disease management, leading to fundamental shifts in corresponding medical insurance policies and disease management models. The American Academy of Sleep Medicine (AASM) is the first organization worldwide to provide telemedicine-based sleep diagnosis and treatment services. Sleep medicine in China has also developed rapidly in recent years, influenced by the COVID-19 pandemic,Monitoring of sleep-related breathing disorders has also received significant attention and promotion, particularly in the field of telemedicine.

Driven by the strong efforts of China’s sleep medicine management organizations and a broad community of clinical sleep specialists, the “Expert Consensus on Clinical Practice of Telemedicine for Adult Obstructive Sleep Apnea-Hypopnea Syndrome” was released in June 2021. In February 2022, the “Expert Consensus on the Standardized Clinical Application of Home Sleep Apnea Testing in Adults” was also successfully published. A novel telemedicine-based diagnosis and treatment model integrating hospitals, communities, and homes has quietly emerged.

Wang Jianjun believes that telemedicine service platforms can help hospitals conserve medical resources and reduce healthcare costs for patients, enabling them to receive end-to-end services—from OSA risk assessment, diagnosis, and provision of targeted treatment devices to home-based medical care—without leaving their homes.The diagnosis and treatment of OSA are gradually becoming more clinical, simplified, and home-based.

Wang Jianjun added that with the development of the internet, mobile devices, artificial intelligence, and wearable devices, a new patient-centered model of remote home-based healthcare for obstructive sleep apnea (OSA) is expected to be established. “This remote sleep monitoring and treatment system will become a development trend, meeting the growing medical needs of patients with sleep disorders and promoting public sleep health.”

“OSA is an independent risk factor for cardiovascular and cerebrovascular diseases. Approximately 50% of patients with OSA have hypertension, and at least 30% of patients with hypertension have OSA. The strong correlation between OSA and hypertension has been recognized and emphasized by most clinicians,” said Wang Wenjing. “China’s respiratory medicine specialty has entered a phase focused on the management of chronic respiratory diseases and pulmonary rehabilitation. Chronic airway diseases such as chronic obstructive pulmonary disease (COPD), asthma, and sleep apnea are characterized by significant health hazards, large affected populations, and severe complications. Similar to hypertension and diabetes, these conditions face increasing pressure for chronic disease prevention and control at the primary care level.”Therefore, the use of appropriate technologies to rapidly and conveniently screen for OSA and refer patients to sleep medicine centers for treatment will be an effective means to further improve the awareness, treatment, and standardized management rates of OSA.

With Special ThanksChengyi Jiaren, Zhaoguan TechnologyStrong support for this article.