Sleep apnea is common — but rarely diagnosed — among black Americans.
The new study included 852 black men and women, average age 63, in Jackson, Miss., who were participants in the Jackson Heart Sleep Study.
About 80 percent to 90 percent of Americans with sleep apnea are un-diagnosed, and black Americans account for a large number of such people, according to recent research.
The investigators found that 24 percent of the study participants had moderate or severe sleep apnea, but only 5 percent had been diagnosed by a doctor.
"In other words, over 95 percent of this sample experience nightly stresses associated with periods when breathing stops and oxygen levels fall," said study author Dayna Johnson, an associate epidemiologist in the division of sleep and circadian disorders at Brigham and Women’s Hospital in Boston.
"Untreated sleep apnea can increase risk for hypertension-related diseases such as stroke, a condition disproportionately common in African-Americans," Johnson said in a hospital news release.
In the study, men were 12 percent to 15 percent more likely to have sleep apnea than women. Participants with chronic snoring, higher body mass index (an estimate of body fat based on height and weight) and larger neck size were more likely to have sleep apnea.
"We also learned that asking about habitual snoring and measuring neck size (a risk factor for sleep apnea) can help identify individuals at risk," Johnson added.
African Americans with sleep apnea and insomnia are rarely diagnosed with either problem, even when the severity of the two sleep disorders are likely to affect their health. This is according to research presented at the ATS 2017 International Conference.
“African Americans experience a disproportionate burden of numerous health problems, including obesity, diabetes, hypertension, and cardiovascular disease, all of which have been shown to be associated with sleep,” says lead study author Dayna A. Johnson, PhD, MPH, MS, MSW, a postdoctoral research fellow at Brigham and Women’s Hospital and Harvard Medical School, in a release. “It seems plausible that sleep apnea and insomnia are important risk factors contributing to these health disparities.”
Johnson and her colleagues studied data of 825 African Americans who underwent a sleep study as part of the Jackson (Miss) Heart Study, which is funded by the National Institutes of Health and is the largest single-site prospective investigation of cardiovascular disease in African Americans undertaken. The average age of those undergoing the home sleep study was 63 years, and two-thirds of the participants were women.
The study found that three of every four participants had sleep apnea: 38.4% had mild sleep apnea; 21.3% had moderate sleep apnea; and 15.8% had severe sleep apnea. But only 2.1% of those with sleep apnea reported that a physician diagnosed the condition.
Higher body mass index, hypertension, diabetes, being male, and being older were all associated with sleep apnea and its severity.
The study also found that more than 2 in 10 participants suffered from insomnia. But only 6.7% of them reported a physician diagnosis.
According to Johnson, the prevalence of both sleep apnea and insomnia in the study population was higher than would be expected in the general population of adults of a similar age.
“There is a disturbingly high prevalence of undiagnosed sleep disorders in our study population of African Americans,” she says. “It is important to investigate the reasons for this high prevalence as well as investigate interventions targeted at increasing awareness and screening for sleep disorders.”
Because treating these sleep disorders “could drastically improve quality of life and reduce the burden of subsequent adverse health outcomes,” Johnson adds, clinicians need to identify patients at risk of these sleep disorders and encourage them to undergo sleep studies. In addition, although public awareness of sleep apnea is growing, efforts targeting the most at-risk populations may be warranted.
Johnson says that study findings from the Jackson, Miss, metropolitan area may not apply to African Americans living elsewhere. “African Americans living in Jackson, Miss, may not be representative of all African Americans due to differences in risk factors that may be related to geography,” she says.
Sleep apnea is associated with an increased risk of heart disease, high blood pressure (hypertension), diabetes and other health problems. About 80 percent to 90 percent of Americans with sleep apnea are un-diagnosed, and black Americans account for a large number of such people, the study authors noted.
Michael Twery is director of the National Center on Sleep Disorders Research, part of the U.S. National Heart, Lung, and Blood Institute. He said, "These findings in the Jackson Heart Study reveal that sleep apnea is under-diagnosed and a potential threat to the health and safety of African-Americans."
According to Twery, who was not involved with the new report, "Further studies are needed to develop the tools and systems required to facilitate diagnosis and treatment of sleep apnea in African-Americans and other communities."
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