Recognition and Treatment of Sleep-disordered Breathing in Obese African American Hospitalized Patients may Improve Outcome

Abstract

word count : 264 Manuscript word count : 2528 ABSTRACT PURPOSE:The HoSMed Database recently demonstrated a high prevalence of obstructive sleep apnea (OSA) in hospitalized obese patients. Based on a long-term follow-up, this study showed an improved survival among patients who were adherent with the therapy. In this post-hoc analysis we explore the characteristics, associations, and mortality outcome of OSA in the African American (AA) population. METHODS:These subset analyses included obese AA patients screened in the hospital as high-risk for OSA.Stepwise logistic regression analysis was used to identify predictors of OSA. Patients who had polysomnography (PSG) and were initiated on positive airway pressure (PAP) therapy were followed and dichotomized to adherent versus non-adherent groups based on compliance data.Mortality rates in both groups were compared. RESULTS:Of the total of 2022 AA patients screened, 1370 (60.7% females) were identified as high risk for OSA. Of these, 279 had PSG diagnosed OSA (mean AHI = 36 /hour) and were initiated on PAP therapy. Adherence in AAs was significantly lower than for Caucasians (21% versus 45%, Chisquare p<0.0001). The following statistically significant predictors of OSA were found: heart failure, chronic kidney disease, hypertension and asthma/COPD, BMI and age. A Log-rank Recognition and Treatment of Sleep Disordered Breathing in African Americans 3 survival analysis of AAs on CPAP showed non-significant benefit of adherence (HR: 0.22; 95% CI 0.03 -1.7, p=0.11); a propensity analysis of AAs and Caucasians that adjusted for race and potential confounding variables found a statistically significant benefit of adherence (HR: 0.29; 0.13-0.64; p=0.002). CONCLUSION:This large database of hospitalized patients confirms a high prevalence and lower adherence to PAP therapy in African Americans. Adherent patients, however, showed mortality benefit similar to Caucasians.

Are symptoms of obstructive sleep apnoea related to good continuous positive airway pressure compliance?

“…It was comparable to that found in African-American patients with OSA (20.59% versus 21%) and lower than those found in White (45%) or Latino (56.3%) patients [ 12 , 13 ]. Possible explanations for the low CPAP compliance in these populations include low socioeconomic status, poor understanding of the consequences of OSA, cultural factors, short sleep duration, and insomnia [ 12 , 14 , 15 ]. Another factor that may have affected CPAP compliance was age.…”

Disparities in Sleep Health and Potential Intervention Models

“…OSA may be more prevalent in nonwhites but is also more severe at the time of diagnosis. 38,39 OSA is more likely to be underdiagnosed in nonwhites. This is demonstrated in the Hispanic Community Health Study, 40 in which 14% had apnea-hypopnea index (AHI) $15 but only 1% clinical diagnosis, and the Jackson Heart Study, 41 in which 24% had AHI $15 but only 5% had a physician diagnosis of OSA.…”

Undiagnosed OSA May Significantly Affect Outcomes in Adults Admitted for COPD in an Inner-City Hospital

“…AA patients and those living in poorer neighborhoods areas have been shown to have higher readmission rates and a greater prevalence of unrecognized OSA. 2,15,16 Furthermore, they are less likely to seek treatment for OSA and be adherent to CPAP. 17 Lower socioeconomic status as well as cultural factors such as lower marriage rates at time of OSA diagnosis and a more tolerant attitude toward snoring have been suggested as explanatory factors.…”

“…7 Although AA patients have been found to have low rates of following up with sleep diagnostic studies and subsequent PAP therapy, 15 those who do follow-up are compliant with PAP therapy have improved survival. 16 We identify this as a major area of vulnerability and a health disparity issue. Further studies are required to test whether early intervention with PAP therapy in hospitalized patients with COPD with OSA, especially those who are AA, will affect outcomes.…”