Study Finds Black Men Have More Severe Obstructive Sleep Apnea When First Diagnosed

An African-American man wearing cpap mask while laying in bed
Future research is needed to determine why Black men experience delayed diagnosis of OSA and to identify test interventions that might alleviate this delay.

Black individuals — especially Black men — have more symptoms of obstructive sleep apnea (OSA) on clinical presentation as well as more severe OSA on polysomnography, according to a study on racial and gender disparities in OSA published in the Annals of the American Thoracic Society.

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

Of the individuals included in the study, 50.6% were Black and 49.4% were White. Men accounted for 56% of White participants vs 31% of Black participants (P <.001). Overall, the cohort of patients with OSA comprised 141 Black men (15.8%), 248 White men (27.9%), 309 Black women (34.7%), and 192 White women (21.6%).

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

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 with 39.0±28.9 events per hour in White men, 33.4±32.3 events per hour in Black women, and 26.2±23.8 events per hours in White women (P <.001).

Additionally, the greatest burden of OSA symptoms was reported in Black men, based on mean Epworth Sleepiness Scale scores (12.2±5.9 compared with 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 had an approximately 60% greater likelihood than White men of reporting that they had witnessed 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 investigators concluded that future work is warranted to determine the reasons for delayed diagnosis of OSA in Black men and to identify test interventions that might alleviate these delays.

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

Disclosure: One of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures. 


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