Disparities in Obstructive Sleep Apnea and Its Management between a Minority-Serving Institution and a Voluntary Hospital

ABSTRACT

We assessed disparities in severity of obstructive sleep apnea (OSA) and associated comorbidities, as well as in provision of sleep medicine health care, between patients evaluated for OSA in a voluntary hospital (VH) primarily serving a middle-class population with health-care insurance and a city hospital-based minority-serving institution (MSI) largely treating lower income, uninsured, and indigent patients. A retrospective chart review of patients evaluated for OSA at the VH (n = 200) and at the MSI (n = 103) was performed. Despite similar age and apnea hypopnea index, MSI patients had a greater body mass index, higher daytime systemic blood pressure, more comorbid medical conditions, and a lower minimum sleep SaO₂ than VH patients. Systemic hypertension, diabetes mellitus, asthma, and congestive heart failure were more prevalent in the MSI group. Forty-two percent of the MSI patients diagnosed with OSA failed to follow up for treatment compared with 7% in the VH group, p < 0.001. Disparities in OSA-associated comorbid conditions, as well as in delivery of sleep medicine-related health care, were evident between the VH and MSI groups. These findings suggest that OSA may be an important factor contributing to socioeconomic-based differences in morbidity and mortality.

KEYWORDS

Sleep apnea - socioeconomic status - disparity

REFERENCES

• 1 Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults.  N Engl J Med. 1993;  328 1230-1235
• 2 Young T, Palta M, Dempsey J et al.. Prospective study of the association between sleep-disordered breathing and hypertension.  N Engl J Med. 2000;  342 1378-1384
• 3 Nieto F J, Young T B, Lind B K et al.. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study.  JAMA. 2000;  283 1829-1836
• 4 Young T, Blustein J, Finn L, Palta M. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults.  Sleep. 1997;  20 608-613
• 5 Kapur V K, Redline S, Nieto F J, Young T B, Newman A B, Henderson J A. The relationship between chronically disrupted sleep and healthcare use.  Sleep. 2002;  25 289-296
• 6 Punjabi N M, Welch D, Strohl K. Sleep disorders in regional sleep centers: a national cooperative study; Coleman II study investigators.  Sleep. 2000;  23 471-480
• 7 Wong M D, Shapiro M F, Boscardin W J, Ettner S L. Contribution of major diseases to disparities in mortality.  N Engl J Med. 2002;  347 1585-1592
• 8 Dement W C, Netzer N C. Primary care: is it the setting to address sleep disorders?.  Sleep Breath. 2000;  4 1-9
• 9 Hulshof K F, Brussaard J H, Kruizinga A G, Telman J, Lowik M R. Socio-economic status, dietary intake and 10 y trends: the Dutch National Food Consumption Survey.  Eur J Clin Nutr. 2003;  57 128-137
• 10 Lantz P M, House J S, Lepkowski J M, Williams D R, Mero R P, Chen J M. Socioeconomic factors, health behaviors and mortality: results from a nationally representative prospective study of US adults.  JAMA. 1998;  279 1703-1708
• 11 Punjabi N M, Sorkin J D, Katzel L I, Goldberg A P, Schwartz A R, Smith P L. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men.  Am J Respir Crit Care Med. 2002;  165 677-682
• 12 Fletcher E C. Physiological consequences of intermittent hypoxia: systemic blood pressure.  J Appl Physiol. 2001;  90 1600-1605
• 13 Hosselet J, Ayapa I, Norman R G, Krieger A C, Rapoport D M. Classification of sleep-disordered breathing.  Am J Respir Crit Care Med. 2001;  163 398-405