India is estimated to have over 10 crore adults affected by obstructive sleep apnoea (OSA).[1,2,3] This intersects with the country’s dual burden of diabetes and cardiovascular disease.[4] Untreated OSA worsens glycaemic control, hypertension, arrhythmias and accident risk. While in-lab polysomnography (Level-1) remains the gold standard, its scalability is limited by cost and capacity constraints. The opportunity for India lies in validated, accessible and affordable alternatives delivered within a framework of standardisation and quality control.
SLEEP HEALTH AS A PILLAR OF WELL-BEING
Healthy sleep is now recognised as a vital, multidimensional component of overall well-being—on par with nutrition, physical activity and mental health.[5] Poor sleep affects metabolic, cardiovascular and neurocognitive outcomes, contributing significantly to India’s growing burden of chronic disease. Beyond clinical diagnostics, the increasing availability of wearable devices—such as Actigraphy, Apple Watch™, Samsung™ and Fitbit™—has transformed public awareness around sleep health. While these devices have limitations, the recent 2024 United States Food and Drug Administration (US FDA) clearance for Apple and Samsung devices to identify the risk of sleep apnoea highlights their emerging potential in early detection and public engagement.
EPIDEMIOLOGICAL SNAPSHOT[1,2,3]
Multiple Indian studies report OSA prevalence ranging from 9% to 20% in urban adults and 30% to 40% among high-risk populations such as those with diabetes or metabolic syndrome [Table 1].[6] A 2017 meta-analysis confirmed rates comparable to Western cohorts,[7] yet most patients remain undiagnosed.
Table 1.
Selected Indian studies describing OSA prevalence
| Study (Year) | Population | Sample Size | Method | Prevalence | Key Findings |
|---|---|---|---|---|---|
| Udwadia et al., 2004[1] | Urban men, Mumbai | 450 | PSG | 19.5% | Higher in obese and hypertensive men |
| Sharma et al., 2006 [2] | Delhi population | 1,506 | Questionnaire + PSG subset | OSA 9.3%; OSAHS 2.8% | Snoring 14%; obesity and hypertension key risks |
| Reddy et al., 2009[3] | Delhi adults | 1,990 | Questionnaire + PSG subset | OSA 13.7%; OSAHS 3.6% | Substantial undiagnosed burden |
| Mishra et al., 2014[4] | Metabolic syndrome, Pune | 250 | PSG | 35–40% | Very high in metabolic syndrome |
| Senaratna et al., 2017[5] | Diabetes, South India | 300 | PSG | >40% | Strong association with diabetes |
| Reddy R et al., 2017[6] | Meta-analysis | 12 studies | Mixed | Men 13–17%; Women 7–9% | Burden comparable to the West |
OSA – Obstructive Sleep Apnoea, OSAHS – Obstructive Sleep Apnoea–Hypopnoea Syndrome, PSG – Polysomnography
CURRENT SCENARIO IN INDIA
Despite growth in sleep labs across AIIMS and other teaching hospitals and private centres, India’s sleep medicine ecosystem remains underdeveloped. There are approximately 250 dedicated sleep lab beds nationwide, performing about two lakh studies annually. However, quality and physician oversight vary widely. Around 55,000 Continuous Positive Airway Pressure (CPAP) devices were sold in 2023, far below the need. Over 55% of Indian healthcare spending is out-of-pocket, limiting affordability. The recent revision of Central Government Health Scheme (CGHS) reimbursement rates for sleep studies is a welcome policy step likely to improve access. There is currently a major gap in sleep medicine training and credentialling, which hampers growth and consistency in clinical practice. Establishing structured educational programs and accreditation systems for sleep physicians and technologists is essential to support standardisation, quality assurance and confidence in emerging diagnostic models.
THE CASE FOR STANDARDISATION AND INNOVATION
India urgently needs national practice standards and a framework to stimulate innovation in sleep testing. International clinical practice guidelines now support validated home-based and simplified diagnostic pathways for appropriately selected adult patients.[8] Standards should define patient eligibility, minimum technical requirements, scoring protocols and quality assurance processes. A parallel focus on innovation will allow India to adapt new sensor technologies and AI-assisted analytics to its unique healthcare environment. In India, there remains a strong insistence on Level-1 laboratory testing as the ‘gold standard’, and current reimbursement structures—including the CGHS schedule—do not routinely cover home-based or simplified testing modalities. This has created a practical barrier to wider access, especially in smaller towns and tier-2 cities where laboratory-based testing is either unavailable or unaffordable. To make sleep diagnostics scalable and equitable, reimbursement frameworks must evolve to include validated Level-2, Level-3 and emerging sensor-based studies. CGHS and private insurers should explore extending cover to simpler Home Sleep Apnoea Testing (HSAT) tools—but this is only possible once we can demonstrate and assure a mature and standardised pathway, as implemented successfully in many other countries. Collaboration between clinicians, payers and policy bodies is vital to ensure sustainable scale-up.
EVOLVING TECHNOLOGIES IN SLEEP TESTING
Beyond clinical diagnostics, the increasing availability of wearable devices—such as Actigraphy, Apple Watch™, Samsung™, and Fitbit™—has transformed public awareness around sleep health.[9] Recent technological advances are transforming sleep diagnostics. Photoplethysmography and pulse-transit time can detect airflow and respiratory effort. Heart rate variability (HRV) and peripheral arterial tone analysis provide autonomic markers of sleep fragmentation. AI-based algorithms are now automating event detection and scoring, improving efficiency and scalability. Wearable devices—rings, wristbands and radar-based contactless sensors—enable screening beyond the lab. These innovations are particularly relevant for India’s scale, provided quality and validation standards are established.
Opportunities for the Indian Sleep Community: India can leapfrog traditional models by adopting validated, simpler sleep testing tools and pathways, promoting standardisation and fostering innovation. Collaboration with engineering institutions (Indian Institutes of Technology [IITs], startups) can stimulate indigenous solutions tailored to local needs. Standardisation will ensure patient safety, affordability and consistent quality across diverse settings.
CONCLUSION
India is at a turning point in sleep medicine. By developing and enforcing national standards, aligning clinicians and integrating new technology, India has the opportunity to reshape its cardiometabolic health profile.[10,11] This is a moment for passion and purpose. Just as physicians once led seat belt and anti-tobacco movements, the Indian sleep community now has a unique opportunity to change the country’s cardiometabolic future. The way forward lies in developing nationally accepted standards, accreditation processes and shared data registries that can ensure both access and quality. Creating collaborative platforms that bring together clinicians, technologists and policymakers will help build trust in newer testing modalities and support evidence-based reimbursement reform. India has the clinical talent and technological ecosystem to lead in this field—what is needed now is alignment, consistency and a collective vision for scalable, patient-centred and innovation-driven sleep care.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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