Photo courtesy of the American Heart Association
A recent study from the University of Buffalo found that Black men die from obstructive sleep apnea syndrome (OSAS) at a higher rate than their white counterparts and Black women.
In February, the study was published online in Sleep Medicine, highlighting the racial disparity and mortality rate among Black men in the United States. Obstructive Sleep Apnea Syndrome (OSAS) is a “condition characterized by repeated episodes of upper airway closure during sleep.” In addition, several health conditions, such as nonarteritic ischemic optic neuropathy, glaucoma, central retinal vein occlusion, central serous retinopathy, and floppy eyelid syndrome, are linked to OSAS. However, researchers claim no direct causal effect exists with other conditions, including cardiac arrhythmias, decreased oxygen levels, and overly stressful environments.
The study was conducted for two decades from 1999 to 2019, using statistics from the National Center for Health Statistics provided by the Centers for Disease Control and Prevention. Scientists used Joinpoint regression analysis and compared the mortality rate and cause of death between Black and white individuals.
“Despite several epidemiologic studies focusing on the prevalence, risk factors and clinical presentations of sleep apnea, no study, to our knowledge, has evaluated the disparity of sleep apnea-related mortality among different racial groups,” said Yu-Che Lee, MD, first author and a medical resident in the Jacobs School of Medicine and Biomedical Sciences at UB, who sees patients through the Catholic Health System. “We, therefore, brought up an idea to do the research discussing the difference of sleep apnea-related mortality and mortality trends from 1999 to 2019 between Black and white Americans.”
Lee and his colleagues discovered an increase in the mortality rate between 1999 and 2008 among Black men, but rates reduced for Black women and white men and women. Researchers suggested that medical management and public health interventions contributed to the flattening rate in these groups. Moreover, Black men were the leading group to experience a surge in sleep apnea-related deaths in the 21-year study.
“Our study showed that Black men were the only demographic group to have a continuous sleep apnea mortality increase in the last ten years, which is truly concerning,” said Lee.
While several factors led to an increase in mortality rate, compliance with continuous positive airway pressure (CPAP) machines was also associated with sleep apnea deaths among Black men.
“The literature suggests that compliance with CPAP is lower in patients who are Black, are of lower socioeconomic class and may have lower health literacy,” said M. Jeffery Mador, MD, associate professor in the Department of Medicine in the Jacobs School and a study co-author, who sees patients through UBMD Internal Medicine.
“It is extremely likely that deaths occurred because the subjects were untreated or poorly compliant with therapy,” Mador continued. “CPAP therapy is highly effective and very few deaths, if any, would be expected if the subjects were adequately treated, followed and were able to use the therapy.”
He explained that clinicians might be helpful when assisting patients who utilize these machines.
“We have noticed that there is room for improvement in terms of optimizing CPAP usage in our own patients who display the above factors,” he said.
Black male patients are likely at risk due to health conditions going undiagnosed for long periods, causing other issues to formulate in the body.
“Sleep apnea is relatively underdiagnosed in the general population, but this problem may be greater in Black patients,” said Mador.
“Even when diagnosed, successful treatment is lower in Black people than the general population,” he added. “Untreated sleep apnea is associated with higher levels of hypertension, heart disease, stroke and diabetes, all of which are common in Black patients. Hopefully, increasing awareness and improving efficacy of treatment may lead to better health outcomes in this patient population.”
“This is the first study to demonstrate the disparities of sleep apnea-related mortality and different mortality trends between Black and white Americans,” said Lee. “These findings should give clinicians some insights into the problem to develop more tailored strategies and treatments to reduce racial disparities in outcomes from sleep apnea.”