Black men have greater OSA severity, symptoms at time of diagnosis
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In a new study, Black men had the greatest burden of obstructive sleep apnea symptoms and more severe disease at the time of diagnosis, researchers reported in the Annals of the American Thoracic Society.
Researchers obtained data from 890 patients (mean age, 51.4 years; mean apnea-hypopnea index [AHI], 36.4 events per hour; mean BMI, 37.5 kg/m2) with newly diagnosed OSA at University Hospitals Cleveland Medical Center sleep laboratories from 2007 to 2010. Patients completed a questionnaire on demographics and sleep-related symptoms and underwent laboratory polysomnography. Researchers compared OSA symptom severity at time of diagnosis across race and sex.
In the cohort, 15.8% were Black men, 27.9% were white men, 34.7% were Black women and 21.6% were white women.
At diagnosis, Black men had the most severe OSA (mean AHI, 52.4 events per hour) compared with white men (39 events per hour), Black women (33 events per hour) and white women (26.2 events per hour; P < .001 for comparison).
In addition, Black men had the greatest burden of OSA symptoms at diagnosis, with the highest mean Epworth Sleepiness Scale score compared with white men, Black women and white women (12.2 vs. 9.4, 11.2 and 9.8, respectively; P < .001).
Similar proportions of Black men and white men had severe OSA when categorized (58.2% vs. 52.8%, respectively; P = .31), but severe OSA was more prevalent among Black women compared with white women (38.2% vs. 28.1%; P = .02).
Researchers also observed a 60% greater likelihood of Black men reporting witnessed apneas (OR = 1.61; 95% CI, 1.04-2.51) and drowsy driving (OR = 1.56; 95% CI, 1-2.46) at time of diagnosis compared with white men.
“Future work should determine the reasons behind delayed diagnoses and test interventions to mitigate these delays in order to achieve health equity,” the researchers wrote. “Such interventions will need to be effective among both women and men.”
“One explanation for our findings may be that Black patients are not being referred for clinical sleep evaluation as frequently as white patients. Recent work suggests that Black patients experience more barriers in seeing their primary care physicians compared to white patients that may prevent them from being fully assessed. Primary care physicians also refer their Black patients to specialists less frequently than their white patients,” J. Daryl Thornton, MD, MPH, co-director at the Center for Reducing Health Disparities and associate professor in the department of internal medicine in the division of pulmonary, critical care and sleep medicine at the MetroHealth campus of Case Western Reserve University, Cleveland, and colleagues wrote.
The researchers said future research should focus on why there are delayed diagnoses for certain populations and to test strategies to mitigate delays.