Racial Differences in Clinical Presentation of Patients with Sleep-Disordered Breathing

Steven M. Scharf; Lawrence Seiden; Jennifer DeMore; Olivia Carter-Pokras

doi:10.1055/s-2004-860894

Sleep and Breathing, Inhaltsverzeichnis

Sleep Breath 2004; 8(4): 173-183
DOI: 10.1055/s-2004-860894

ORIGINAL ARTICLE

Racial Differences in Clinical Presentation of Patients with Sleep-Disordered Breathing

Steven M. Scharf¹ , Lawrence Seiden² , Jennifer DeMore¹ , Olivia Carter-Pokras³

¹Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Departments of Medicine, University of Maryland Medical Center, Baltimore, Maryland
²Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Departments of Neurology, University of Maryland Medical Center, Baltimore, Maryland
³Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Departments of Epidemiology, University of Maryland Medical Center, Baltimore, Maryland

Abstract

ABSTRACT

We characterized differences in severity, presentation, and treatment compliance in sleep-disordered breathing (SDB) between African Americans (AA) and Caucasians (W). We retrospectively analyzed demographics, proxy measures of socioeconomic position, concurrent illness, presenting complaints, polysomnographic data including respiratory disturbance index (RDI) and time less than 90% O₂ saturation (T90), and acceptance of and long-term compliance with CPAP therapy. Over 1 year there were 128 AA, 102 W, and 3 “other.” AA were younger (44.9 ± 14.1 vs. 49.2 ± 14.5 years; P = 0.022), had greater body mass index (BMI) (39.7± 10.7 vs. 33.4 ± 9.2 kg/m²; p < 0.0001), and reported lower estimated median household income (MHI) than W ($33,365 ± 15,236 vs. $52,641 ± 20,209; p < 0.0001). OSA was more severe among AA: (median RDI: AA 32.9, W 29.1 events/h; p = 0.008; median T90: AA 17.6 vs. W 5.3 per minute; P = 0.006). However, after adjustment for BMI and MHI, differences between AA and W in RDI were not significant. Equal frequencies of AA and W accepted and were compliant with CPAP. We conclude that while AA present with more severe OSA than W this was accounted for by factors known to influence OSA severity. Further, there were no racial differences in accepting and adhering to therapy with CPAP.

KEYWORDS

Obstructive sleep apnea - race - respiratory disturbance index - polysomnography

Volltext

Referenzen

REFERENCES

1 Young T, Peppard P E. Epidemiological evidence for an association of sleep-disordered breathing with hypertension and cardiovascular disease. In: Bradley TD, Floras JS Sleep Apnea: Implications in Cardiovascular and Cerebrovascular Disease New York, NY; Marcel Dekker 2000: 261-283
2 Bixler E O, Vgontzas A N, Lin H M et al.. Association of hypertension and sleep-disordered breathing. Arch Intern Med. 2000; 160 2289-2295
3 Young T, Peppard P E, Gottlieb D. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002; 165 1217-1239
4 Exar E N, Collup N A. The upper airway resistance syndrome. Chest. 1999; 115 1127-1139
5 Ancoli-Israel S, Kilauber M R, Stepnowsky C, Estline E, Chinn A, Fell R. Sleep-disordered breathing in African-American elderly. Am J Respir Crit Care Med. 1995; 152 1946-1949
6 Redline S, Tishler P V, Hans M G, Tosteson T D, Strohl K P, Spry K. Racial differences in sleep-disordered breathing in African-Americans and Caucasians. Am J Respir Crit Care Med. 1997; 155 186-192
7 Cakirer B, Hans M G, Graham G, Aylor J, Tishler P V, Redline S. The relationship between craniofacial morphology and obstructive sleep apnea in whites and in African-Americans. Am J Respir Crit Care Med. 2001; 163 947-950
8 Meetze K, Gillespie M B, Lee F S. Obstructive sleep apnea: a comparison of black and white subjects. Laryngoscope. 2002; 112 1271-1274
9 Smedley BD, Stith AY, Nelson AR Unequal Treatment-Confronting Racial and Ethnic Disparities in Health Care. Report of the Institute of Medicine of the National Academies, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Board on Health Sciences Policy. Washington, DC; National Academic Press 2002 Available at: http://books.nap.edu/books/030908265X/html/R1.html#pagetop. Accessed January 30, 2003
10 Geiger HI, Rubinstein LS The Right to Equal Treatment. Report by Physicians for Human Rights 2002 Available at: http://www.phrusa.org/research/domestic/racial/race_report. Accessed January 30, 2003
11 Krieger J. Long-term compliance with nasal continuous positive airway pressure (CPAP) in obstructive sleep apnea patients and non-apneic snorers. Sleep. 1992; 15 S42-S46
12 Pepin J L, Krieger J, Rodenstein D et al.. Effective compliance during the first 3 months of continuous positive airway pressure. A European prospective study of 121 patients. Am J Respir Crit Care Med. 1999; 160 1124-1129
13 Sin D D, Mayers I, Man G CW, Pawluk L. Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest. 2002; 121 430-435
14 Flemons W W, Reimer M A. Development of a disease-specific health-related quality of life questionnaire for sleep apnea. Am J Respir Crit Care Med. 1998; 158 494-502
15 O’Connor G T, Quinton H B, Kneeland T et al.. Median household income and mortality rate in cystic fibrosis. Pediatrics. 2003; 111 E333-E339
16 Claudio L, Tulton L, Doucette J, Landrigan P J. Socioeconomic factors and asthma in hospitalization rates in New York City. J Asthma. 1999; 36 343-350
17 Philbin E F, McCullough P A, DiSalvo T G, Dec G W, Jenkins P L, Weaver W D. Socioeconomic status is an important determinant of the use of invasive procedures after acute myocardial infarction in New York State. .Circulation. 2000 102: III107-115
18 Carskadan M A, Rechtschaffen A. Monitoring and staging human sleep. In: Kryger M, Roth T, Dement W Principles and Practice of Sleep Medicine. 3rd ed. Philadelphia, PA; WB Saunders Inc 2000: 1197-1215
19 Rechtshaffen A, Kales A A Manual of Standardized Terminology: Techniques and Scoring System for Sleep Stages of Human Subjects. Public Health Service-National Institutes of Health. Neurological Information Network. Bethesda, MD; US Department of Health, Education and Welfare 1968
20 Engleman H M, Asgari-Jirhandeh N, McLeod A, Ramsay C F, Deary I J, Douglas N J. Self-reported use of CPAP and benefits of CPAP therapy: a patient survey. Chest. 1996; 109 1470-1476
21 Hui D SC, Chan J K, Choy D K. Effects of augmented continuous positive airway pressure education and support on compliance and outcome in a Chinese population. Chest. 2000; 117 1410-1416
22 Kribbs N B, Pack A I, Kline L R et al.. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Resp Dis. 1993; 147 887-895
23 McArdle N, Devereux G, Heidarnejad H, Engelman H M, Mackay T W, Douglas N J. Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999; 159 1108-1114
24 Carter-Pokras O, Baquet C. What is a “health disparity”?. Public Health Rep. 2002; 117 426-434
25 Redline S, Tishler P V, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep-disordered breathing in children. Associations with obesity, race and respiratory problems. Am J Respir Crit Care Med. 1999; 159 1527-1532
26 Tishler P V, Larkin E K, Schluchter M D, Redline S. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA. 2003; 289 2230-2237
27 O’Connor G T, Lind B K, Lee E T et al.. Variation in symptoms of sleep-disordered breathing with race and ethnicity: the Sleep Heart Health Study. Sleep. 2003; 26 74-79

Steven M ScharfM.D. Ph.D.

Sleep Disorders Center, Division of Pulmonary and Critical Care, University of Maryland School of Medicine

685 West Baltimore St., MSTF 800

Baltimore, MD 21201-1102

eMail: sscharf@medicine.umaryland.edu