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Sleep Apnea: Comorbidities, Racial Disparities, Weight Guidelines, and Alternatives to CPAP
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Lauren Tobias, MD, FCCP

Click to view more from Pulmonology Data Trends 2023.

References

1. Gottlieb DJ, Punjabi NM. JAMA. 2020;323(14):1389-1400. doi:10.1001/jama.2020.3514
2. Slowik JM et al. Obstructive Sleep Apnea. In: StatPearls. Treasure Island (FL): StatPearls Publishing; December 11, 2022.
3. Bonsignore MR et al. Multidiscip Respir Med. 2019;14:8. doi:10.1186/s40248-019-0172-9
4. Schwartz SW et al. Sleep Breath. 2016;20(3):947-955. doi:10.1007/s11325-016-1316-1
5. Grandner MA et al. Sleep Med. 2016;18:7-18. doi:10.1016/j.sleep.2015.01.020
6. Lee YC et al. Sleep Med. 2022;90:204-213. doi:10.1016/j.sleep.2021.11.014
7. Hudgel DW et al. Am J Respir Crit Care Med. 2018;198(6):e70-e87. doi:10.1164/rccm.201807-1326ST
8. Lloyd R et al. J Clin Sleep Med. 2022;18(11):2673-2680. doi:10.5664/jcsm.10244
9. Nokes B et al. Expert Rev Respir Med. 2022;16(8):917-929. doi:10.1080/17476348.2022.2112669
10. Pinto JA et al. Int Arch Otorhinolaryngol. 2016;20(2):145-150.doi:10.1055/s-0036-1579546
11. Georgoulis M et al. J Clin Sleep Med. 2022;18(5):1251-1261. doi:10.5664/jcsm.9834
12. Askland K et al. Cochrane Database Syst Rev. 2020;4(4):CD007736. doi:10.1002/14651858.CD007736.pub3
13. Jugé L et al. Sleep. 2022;45(6):zsac044. doi:10.1093/sleep/zsac044
14. Strollo PJ Jr et al. N Engl J Med. 2014;370(2):139-149. doi:10.1056/NEJMoa1308659
15. Fattal D et al. J Clin Sleep Med. 2022;18(12):2723-2729. doi:10.5664/jcsm.10190
16. He M et al. Otolaryngol Head Neck Surg. 2019;161(3):401-411. doi:10.1177/0194599819840356

Author and Disclosure Information

Lauren Tobias, MD, FCCP
Assistant Professor
Department of Pulmonary, Critical Care & Sleep Medicine
Yale University School of Medicine;
Medical Director
Sleep Program
VA Connecticut
Yale-New Haven Hospital
New Haven, CT

Publications
MDedge Internal Medicine
CHEST Physician
Topics
Sleep Medicine
Author(s)
Lauren Tobias, MD, FCCP
Author(s)
Lauren Tobias, MD, FCCP
Author and Disclosure Information

Lauren Tobias, MD, FCCP
Assistant Professor
Department of Pulmonary, Critical Care & Sleep Medicine
Yale University School of Medicine;
Medical Director
Sleep Program
VA Connecticut
Yale-New Haven Hospital
New Haven, CT

Author and Disclosure Information

Lauren Tobias, MD, FCCP
Assistant Professor
Department of Pulmonary, Critical Care & Sleep Medicine
Yale University School of Medicine;
Medical Director
Sleep Program
VA Connecticut
Yale-New Haven Hospital
New Haven, CT

Click to view more from Pulmonology Data Trends 2023.

Click to view more from Pulmonology Data Trends 2023.

References

1. Gottlieb DJ, Punjabi NM. JAMA. 2020;323(14):1389-1400. doi:10.1001/jama.2020.3514
2. Slowik JM et al. Obstructive Sleep Apnea. In: StatPearls. Treasure Island (FL): StatPearls Publishing; December 11, 2022.
3. Bonsignore MR et al. Multidiscip Respir Med. 2019;14:8. doi:10.1186/s40248-019-0172-9
4. Schwartz SW et al. Sleep Breath. 2016;20(3):947-955. doi:10.1007/s11325-016-1316-1
5. Grandner MA et al. Sleep Med. 2016;18:7-18. doi:10.1016/j.sleep.2015.01.020
6. Lee YC et al. Sleep Med. 2022;90:204-213. doi:10.1016/j.sleep.2021.11.014
7. Hudgel DW et al. Am J Respir Crit Care Med. 2018;198(6):e70-e87. doi:10.1164/rccm.201807-1326ST
8. Lloyd R et al. J Clin Sleep Med. 2022;18(11):2673-2680. doi:10.5664/jcsm.10244
9. Nokes B et al. Expert Rev Respir Med. 2022;16(8):917-929. doi:10.1080/17476348.2022.2112669
10. Pinto JA et al. Int Arch Otorhinolaryngol. 2016;20(2):145-150.doi:10.1055/s-0036-1579546
11. Georgoulis M et al. J Clin Sleep Med. 2022;18(5):1251-1261. doi:10.5664/jcsm.9834
12. Askland K et al. Cochrane Database Syst Rev. 2020;4(4):CD007736. doi:10.1002/14651858.CD007736.pub3
13. Jugé L et al. Sleep. 2022;45(6):zsac044. doi:10.1093/sleep/zsac044
14. Strollo PJ Jr et al. N Engl J Med. 2014;370(2):139-149. doi:10.1056/NEJMoa1308659
15. Fattal D et al. J Clin Sleep Med. 2022;18(12):2723-2729. doi:10.5664/jcsm.10190
16. He M et al. Otolaryngol Head Neck Surg. 2019;161(3):401-411. doi:10.1177/0194599819840356

References

1. Gottlieb DJ, Punjabi NM. JAMA. 2020;323(14):1389-1400. doi:10.1001/jama.2020.3514
2. Slowik JM et al. Obstructive Sleep Apnea. In: StatPearls. Treasure Island (FL): StatPearls Publishing; December 11, 2022.
3. Bonsignore MR et al. Multidiscip Respir Med. 2019;14:8. doi:10.1186/s40248-019-0172-9
4. Schwartz SW et al. Sleep Breath. 2016;20(3):947-955. doi:10.1007/s11325-016-1316-1
5. Grandner MA et al. Sleep Med. 2016;18:7-18. doi:10.1016/j.sleep.2015.01.020
6. Lee YC et al. Sleep Med. 2022;90:204-213. doi:10.1016/j.sleep.2021.11.014
7. Hudgel DW et al. Am J Respir Crit Care Med. 2018;198(6):e70-e87. doi:10.1164/rccm.201807-1326ST
8. Lloyd R et al. J Clin Sleep Med. 2022;18(11):2673-2680. doi:10.5664/jcsm.10244
9. Nokes B et al. Expert Rev Respir Med. 2022;16(8):917-929. doi:10.1080/17476348.2022.2112669
10. Pinto JA et al. Int Arch Otorhinolaryngol. 2016;20(2):145-150.doi:10.1055/s-0036-1579546
11. Georgoulis M et al. J Clin Sleep Med. 2022;18(5):1251-1261. doi:10.5664/jcsm.9834
12. Askland K et al. Cochrane Database Syst Rev. 2020;4(4):CD007736. doi:10.1002/14651858.CD007736.pub3
13. Jugé L et al. Sleep. 2022;45(6):zsac044. doi:10.1093/sleep/zsac044
14. Strollo PJ Jr et al. N Engl J Med. 2014;370(2):139-149. doi:10.1056/NEJMoa1308659
15. Fattal D et al. J Clin Sleep Med. 2022;18(12):2723-2729. doi:10.5664/jcsm.10190
16. He M et al. Otolaryngol Head Neck Surg. 2019;161(3):401-411. doi:10.1177/0194599819840356

Publications
MDedge Internal Medicine
CHEST Physician
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CHEST Physician
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Sleep Medicine
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Sleep Apnea: Comorbidities, Racial Disparities, Weight Guidelines, and Alternatives to CPAP
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Sleep Apnea: Comorbidities, Racial Disparities, Weight Guidelines, and Alternatives to CPAP
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Obstructive sleep apnea (OSA) is a disorder in which the upper airway repeatedly collapses during sleep, resulting in hypoxemia and sleep disruption. Approximately 9-17% of women and 25-30% of men in the United States are diagnosed with OSA.1,2 Patients may present with a range of symptoms, including daytime sleepiness, snoring, breathing pauses, or unexplained awakenings from sleep.1 OSA severity is classified according to the apnea-hypopnea index (AHI), and defined by the presence of either ≥ 15 events per hour or 5-14 events per hour with symptoms such as excessive daytime sleepiness, insomnia, or impaired sleep-related quality of life.1 OSA has been associated with stroke, hypertension, atrial fibrillation, coronary artery disease, heart failure, and mood disorders.3 Continuous positive airway pressure (CPAP) is the standard of care for treating OSA in most patients and is highly cost-effective.4

Unfortunately, racial disparities exist in sleep apnea, as with sleep health generally. Black individuals have disproportionately high rates of OSA and higher OSA severity in comparison with White patients.5 Racial inequity also exists in disease outcomes and sleep apnea-related mortality.5,6 CPAP adherence may be lower in marginalized racial groups, with Black patients demonstrating lower nightly CPAP usage.4 Initiatives are needed to improve sleep health equity, such as through increased access to sleep care through telehealth, lessening barriers to sleep apnea diagnostics, and reducing structural inequities associated with CPAP treatment including cost.

Obesity is a well-established risk factor for sleep apnea, and all patients whose body mass index (BMI) is elevated should be counseled on weight loss.7,8 For patients unable to acclimate to CPAP, alternatives are available; there was increased reliance upon these during the recent major CPAP recall.9 Some alternatives include mandibular advancement devices, positional therapy, and hypoglossal nerve stimulation therapy.9 Emerging research is exploring the possibility of drug therapy to manage sleep apnea in the future.9

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