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Sleep apnea and insomnia in African-Americans goes undiagnosed

May 22, 2017

ATS 2017, WASHINGTON, DC--African Americans with sleep apnea and insomnia are rarely diagnosed with either problem, even when the severity of the two sleep disorders are likely to affect their health, according to new research presented at the ATS 2017 International Conference.

"African Americans experience a disproportionate burden of numerous health problems, including obesity, diabetes, hypertension and cardiovascular disease, all of which have been shown to be associated with sleep," said lead study author Dayna A. Johnson, PhD, MPH, MS, MSW, a postdoctoral research fellow at Brigham and Women's Hospital and Harvard Medical School. "It seems plausible that sleep apnea and insomnia are important risk factors contributing to these health disparities."

Dr. Johnson and her colleagues studied data of 825 African Americans who underwent a sleep study as part of the Jackson (Miss.) Heart Study, which is funded by the National Institutes of Health and is the largest single-site prospective investigation of cardiovascular disease in African Americans undertaken. The average age of those undergoing the home sleep study was 63 years, and two-thirds of the participants were women.

The researchers defined sleep apnea, which produces pauses in breathing, based on the apnea-hypopnea index (AHI), which measures the number of pauses that occur per hour of sleep. An AHI >5 was considered mild; an AHI >15, moderate; and an AHI >30, severe. The researchers used the Women's Health Initiative (WHI) Insomnia Rating Scale, a commonly used assessment of perceived insomnia symptoms, to define insomnia. Participants with a score >10 were considered to have insomnia. Participants were asked if a physician had told them that they suffered from either of the disorders.

The study found that three of every four participants had sleep apnea: 38.4 percent had mild sleep apnea; 21.3 percent had moderate sleep apnea; and 15.8 percent had severe sleep apnea. But only 2.1 percent of those with sleep apnea reported that a physician diagnosed the condition.

Higher body mass index, hypertension, diabetes, being male and being older were all associated with sleep apnea and its severity.

The study also found that more than 2 in 10 participants suffered from insomnia. But only 6.7 percent of them reported a physician diagnosis.

According to Dr. Johnson, the prevalence of both sleep apnea and insomnia in the study population was higher than would be expected in the general population of adults of a similar age.

"There is a disturbingly high prevalence of undiagnosed sleep disorders in our study population of African Americans," she said. "It is important to investigate the reasons for this high prevalence as well as investigate interventions targeted at increasing awareness and screening for sleep disorders."

Because treating these sleep disorders "could drastically improve quality of life and reduce the burden of subsequent adverse health outcomes," Dr. Johnson added, clinicians need to identify patients at risk of these sleep disorders and encourage them to undergo sleep studies. In addition, although public awareness of sleep apnea is growing, efforts targeting the most at-risk populations may be warranted.

Dr. Johnson said that study findings from the Jackson, Miss., metropolitan area may not apply to African Americans living elsewhere. "African Americans living in Jackson, Mississippi, may not be representative of all African Americans due to differences in risk factors that may be related to geography," she said.
Contact for Media: Dayna A. Johnson, PhD, MPH, MS, MSW,

Abstract 10044

Undiagnosed Sleep Disorders in African Americans: The Jackson Heart Study

Authors: D.A. Johnson1, R. Wang1, M. Rueschman2, J. Wilson3, S.S. Redline1; 1Harvard Medical School and Brigham and Women's Hospital - Boston, MA/US, 2Brigham and Women's Hospital - Boston, MA/US, 3University of Mississippi Medical Center - Jackson, MS/US

Background: Despite the high prevalence of sleep disorders, a large proportion of the affected population remains undiagnosed, particularly African Americans. Undiagnosed sleep disorders can lead to daytime sleepiness which impacts daily functioning and increases risk of cardiovascular disease. Using data from Jackson Heart Study (JHS) Sleep Study, we determined the prevalence of undiagnosed sleep disorders and identified factors related to diagnosis of a sleep disorder in 825 African Americans.

Methods: Between 2012 and 2015, JHS participants underwent an in-home sleep apnea study with measurement of nasal pressure, abdominal and thoracic inductance plethysmography, oximetry, position, ECG and completed standardized measurements and questionnaires. Sleep apnea was defined as an apnea-hypopnea index (AHI) >5 (mild),

>15 (moderate), and >30 (severe). The Women's Health Initiative (WHI) Insomnia Rating scale >10 was used to assess insomnia. Physician-diagnosis of sleep disorders were self-reported. Probabilities of physician-diagnosed sleep apnea and insomnia conditioned on AHI defined sleep apnea and WHI derived insomnia were calculated. Logistic regression models were fit to determine the associations of age, sex, body mass index (BMI), daytime sleepiness (Epworth Sleepiness Scale > 10), self-reported history of hypertension and diabetes with undiagnosed and diagnosed sleep disorders.

Results: The sample was mostly female (66.6%) with a mean age of 63.0 (standard deviation=10.7) years and a mean BMI of 32.1 (7.0) kg/m2. The median AHI was 10.7 events/hr and the median WHI insomnia score was 5.0. Approximately 75% of the sample had AHI>5 (38.4%(mild), 21.3%(moderate), 15.8%(severe)); whereas 2.1% reported a physician- diagnosis of sleep apnea. Approximately 22.2% had a WHI>10; whereas 2.4% reported a physician-diagnosis of insomnia. Among individuals with AHI>5, 2.4% had a physician-diagnosis of sleep apnea. Only 6.7% of participants with WHI>10 had a physician-diagnosis of insomnia. Male sex, older age, higher BMI, hypertension, and diabetes were independently associated with undiagnosed moderate sleep apnea, P<0.05. Similar associations were observed for mild and severe sleep apnea. A higher AHI and BMI were associated with a physician-diagnosis of sleep apnea, P<0.05.

Higher reported daytime sleepiness was associated with undiagnosed insomnia, while younger age was associated with a physician-diagnosis of insomnia, P<0.05.

Conclusions: The prevalence of undiagnosed sleep disorders among individuals with clinically significant levels of insomnia and sleep apnea were 93.3% and 97.6%, respectively. These results suggest that there is a significant burden of undiagnosed sleep disorders in African Americans, and emphasize a need to improve recognition and treatment across population groups.


Dacia Morris
ATS Office 212-315-8620 (until May 17)
Cell Phone 917-561-6545

Session: B20 Big Data Comes to Sleep Medicine
Abstract Presentation Time: Monday, May 22, 9:45 a.m. ET
Location: Walter E. Washington Convention Center, Room 152A-B (Middle Bldg., Street Level)

American Thoracic Society

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