Sleep apnea-related mortality continuously increased in Black men in US over past 2 decades

A new study published in Sleep Medicine highlights an uptrend in sleep-related mortality and associated cardiovascular disease outcomes among Black men in the U.S.

“Overall, a steady increase in mortality was seen from 1999 to 2008, but the rate remained flat throughout the remainder of the study period. This pattern was observed in Black females and both genders for whites. However, Black males are the only demographic group that had a continuous increase in mortality between 1999 and 2019,” Yu-Che Lee, MD, MPH, resident physician in the department of medicine at the University of Buffalo-Catholic Health System, New York, and colleagues wrote.

Researchers obtained sleep apnea-related mortality data from 1999 to 2019 from the CDC’s National Center for Health Statistics. Using 17,053 identified deaths, researchers assessed mortality trends for sleep apnea before comparing associated outcomes and causes of death between Black vs. white patients with sleep apnea.

“To our knowledge, despite several epidemiologic studies focusing on the prevalence, risk factors and clinical presentations of sleep apnea, no study has evaluated the disparity of sleep apnea-related mortality among different racial groups,” Lee and colleagues wrote.

Of the 17,053 sleep apnea-related deaths, 14,127 occurred in white individuals, 2,593 Black individuals, 142 American Indian or Alaska Native individuals, 191 Asian or Pacific Islander individuals and 911 Hispanic individuals.

Per 1 million population, the overall age-adjusted mortality rates were 2.5 for the entire population, 3.5 for Black individuals and 2.4 for white individuals (P < .001).

Age-adjusted mortality rates rose significantly in Black women from 1999 to 2008 (annual percentage change, 7.5%) and among both White men and women during the same period (annual percentage change, 8.2% and 11.5%, respectively); however, the upward trends did not continue after 2008, the researchers wrote. Among Black men, there was a steady and significant increase in age-adjusted mortality from 1999 to 2019 (annual percentage change, 2.7%).

In the Midwest for both men and women, Black men (4.9 per 1 million population), Black women (4.1 per 1 million population), white men (3.7 per 1 million population) and white women (2.2 per 1 million population) had the highest mortality rates, the researchers reported. In contrast, Black men in the West (2.5 per 1 million population) and, in the Northeast, Black women (2.2 per 1 million population), white men (2.7 per 1 million population) and white women (1.5 per 1 million population) had the lowest mortality rates.

For both men and women sleep apnea decedents, Black individuals had a higher likelihood of having multiple causes of death, including cardiac arrest, hypertension, obesity and chronic renal failure. Arrhythmia remained a more common cause of death among white decedents with sleep apnea (P < .05).

“[T]his population-based study clearly demonstrated the disparities of sleep apnea-related mortality by gender, race and geographic regions in the U.S. ... These findings should spark interest in sleep physicians and public health practitioners for prospective research on the topic of health disparities and better understand causal relationships of disease outcomes among different genders and racial groups,” the researchers wrote.