Racial disparities in obstructive sleep apnea care in the United States

As with much of medicine, racial health disparities exist in the care of patients with obstructive sleep apnea (OSA). These disparities impact all aspects of care from screening and diagnosis to treatment and long-term management. Substantial barriers exist for Black and other historically marginalized racial groups in the US to obtain evaluation for OSA, exacerbated by knowledge deficits about OSA. These barriers result in disease severity being much greater at the time of clinical diagnosis. Many screening and diagnostic tools used in OSA care were adopted based on their utility in White populations without consideration of their performance in other racial groups. For example, the reduced sensitivity of pulse oximetry in detecting desaturations in people with darker skin pigmentation has been heretofore ignored in defining hypopnea. In terms of treatment, outcomes from common therapies are worse in many racial minority groups. Adherence to continuous positive airway pressure (CPAP) is substantially lower and adenotonsillectomy is less effective in resolving OSA and more likely to produce respiratory complications in Black compared to White patients. Many coverage policies further exacerbate racial disparities in OSA care. Interventions such as greater utilization of home sleep apnea testing and automated feedback messaging of CPAP use exist that can help reduce disparities. However, the development of a more diverse workforce and prioritization of health equity in developing every step of OSA care will be necessary to eliminate racial disparities ultimately.