Study shows black men have severe obstructive sleep apnea when they are first diagnosed

Black people – especially black men – have more obstructive sleep apnea (OSA) symptoms on clinical presentation and more severe OSA on polysomnography, according to a study of race and gender differences in OSA published in the Annals of the American Thoracic Society.

The study looked at differences in the characteristics of OSA in 890 adult patients with newly diagnosed OSA who were referred to the sleep laboratories at University Hospitals Cleveland Medical Center in Cleveland, Ohio between February 2007 and December 2010. OSA was defined as the apnea-hypopnea index (AHI) of at least 5 events per hour using polysomnography.

Of the people included in the study, 50.6% were black and 49.4% were white. Men made up 56% of the white participants versus 31% of the black participants (P <.001). Overall, the cohort of patients with OSA included 141 black men (15.8%), 248 white men (27.9%), 309 black women (34.7%), and 192 white women (21.6%).

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All participants completed a standardized questionnaire and underwent laboratory polysomnography. The severity of the patients’ symptoms at the time of assessment was compared based on race and gender. The mean age of the participants was 51.4 ± 14.5 years; the mean AHI was 36.4 ± 32.1 events per hour. The body mass index (BMI) of the patients was increased, with a mean BMI of 37.5 ± 9.9 kg / m2.

Despite the fact that black men were underrepresented among sleep laboratory patients, this group reported the most severe OSA with a mean AHI of 52.4 ± 39.4 events per hour, compared to 39.0 ± 28.9 events per hour in white men, 33.4 ± 32.3 events per hour hour in black women and 26.2 ± 23.8 events per hour in white women (P <0.001).

In addition, the greatest exposure to OSA symptoms was reported in black men based on the Epworth Sleepiness Scale mean scores (12.2 ± 5.9 compared to 9.4 ± 5.2 in white men, 11.2 ± 5.9 in black women and 9.8 ± 5.6 in white women; P <.001). Black men were about 60% more likely than white men to have reported apneas (odds ratio [OR], 1.61; 95% CI 1.04–2.51) and drowsy driving (OR 1.56; 95% CI 1.00–2.46) at the time of their OSA diagnosis.

The researchers concluded that future work is warranted to determine the reasons behind the delayed diagnosis of OSA in black men and to identify testing interventions that could alleviate those delays.

Notably, the participants in this study were a subset of a cohort of patients who participated in a larger, previously published study evaluating genetic risk factors for sleep disorders.

Disclosure: One of the study authors has stated that he belongs to a biotech, pharmaceutical, and / or device company. For a full list of the author’s disclosures, see the original reference.


Thornton JD, Dudley KA, Saeed GJ et al. Differences in symptoms and severity of obstructive sleep apnea between blacks and whites. Ann Am Thorac Soc. Published online July 9, 2021. doi: 10.1513 / AnnalsATS.202012-1483OC

This article originally appeared on Pulmonology Advisor

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