Racial Disparities in Surgical Treatment of Obstructive Sleep Apnea

Cohen, Samuel M.; Howard, Javier J M; Jin, Michael C.; Qian, Z Jason; Capasso, Robson

doi:10.1177/2473974x221088870

Cited by 6 publications

(2 citation statements)

References 56 publications

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“…27 Some studies also reported racial and ethnic disparities but had varied associations based on the type of study. Two large national database studies from the United States reported a lower likelihood of surgery among Black and Hispanic individuals, 25,28 whereas another single institutional study from the United States observed a higher number of Hispanic patients undergoing surgical treatment for OSA. 24 Some of the studies also reported the impact of comorbidities and symptom severity in treatment type as such, patients with fewer comorbidities had a higher chance of receiving PAPalternative treatments.…”

Section: Sociodemographic Factorsmentioning

confidence: 99%

“…22,29 Moreover, reduced rates of surgical treatments were reported among patients with Charlson Comorbidity Score >1 or other conditions that elevated anesthesia risks. 24,28 A general lack of awareness regarding alternative OSA treatment options, 30 importance of improving daytime sleepiness 26 as well as partners witnessing nighttime snoring and apnea 31 were also reported as factors influencing individual decision to receive PAP-alternative treatments. Additionally, studies reporting on income noted that OSA patients with higher income and occupational status were more likely to receive PAP-alternative treatments.…”

Section: Sociodemographic Factorsmentioning

confidence: 99%

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Sociodemographic and Healthcare System Barriers to PAP Alternatives for Adult OSA: A Scoping Review

Singh,

Bhat,

Saroya

et al. 2024

The Laryngoscope

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ObjectiveTo investigate sociodemographic and healthcare system barriers to access and utilization of alternative treatments to positive airway pressure (PAP) in the management of adult obstructive sleep apnea (OSA).Data SourcesPubMed, Embase, and Web of Science databases were searched from 2003 to 2023 for English‐language studies containing original data on sociodemographic and healthcare system barriers to PAP‐alternative treatments for adult OSA.Review MethodsStudies were assessed using the Preferred Reporting Items for Systematic Reviews and Meta‐analyses Extension for Scoping Reviews (PRISMA‐ScR) guidelines. Title and abstract screening, full‐text review, and data collection were conducted by two investigators independently.ResultsOut of 1,615 studies screened, 13 studies met inclusion criteria and reported on a total of 1,206,115 patients who received PAP alternative treatments, including surgery (n = 9 studies), and oral appliances (OAs) (n = 3 studies). The chance of receiving a PAP‐alternative treatment such as surgery was greater among patients aged 39 years or younger, had body mass index below 30 kg/m2, fewer comorbidities, private insurance, and a higher occupational and income status. The decision of individuals to receive PAP alternative treatments was influenced by increased patient education from providers, as well as improvements in daytime sleepiness and partner perception of snoring and apnea.ConclusionCumulative evidence suggests that several sociodemographic and healthcare system factors are associated with decreased use of PAP alternatives when PAP therapy fails. Investigation of interventions to eliminate these potential barriers may improve access and treatment outcomes. Laryngoscope, 2024

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Section: Sociodemographic Factorsmentioning

confidence: 99%

Section: Sociodemographic Factorsmentioning

confidence: 99%

Sociodemographic and Healthcare System Barriers to PAP Alternatives for Adult OSA: A Scoping Review

Singh,

Bhat,

Saroya

et al. 2024

The Laryngoscope

View full text Add to dashboard Cite

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Differences in Positive Airway Pressure Requirements in Obstructive Sleep Apnea Between Black and White Patients

Cai,

Parekh,

Rodin

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveThere are disparities between Black and White patients in the utilization of positive airway pressure (PAP) alternatives for obstructive sleep apnea (OSA). Given low utilization rates among Black patients, there is limited knowledge of PAP alternative outcomes in this group. Therapeutic PAP levels are clinically accessible measures that have been shown to predict PAP alternative outcomes. Herein, we examined differences in PAP requirements between Black and White patients in a large clinical sample.Study DesignCross‐sectional.SettingAcademic sleep center.MethodsWe included OSA patients prescribed autoadjusting PAP between January 2018 and 2020 with baseline apnea‐hypopnea index (AHI) ≥ 10. Mean and 90th percentile PAP levels were compared between White and Black patients who used PAP for ≥1 hour daily using linear regression controlling for age, sex, body mass index (BMI), AHI, oxygen saturation nadir, and mask type.ResultsThere were 157 Black and 234 White patients who were generally obese (BMI, 37.3 ± 8.7) with severe OSA (AHI, 36.9 ± 25.6). Black patients had a 0.68 cm higher (95% confidence interval [CI]: 0.36, 1.35) mean PAP level and 0.85 cm H2O higher (95% CI: 0.36, 1.35) 90th percentile PAP level than white patients. Although statistically significant, differences were small and not clinically meaningful.ConclusionBlack and White OSA patients had clinically insignificant differences in PAP requirements, suggesting comparable upper airway collapsibility. Considering the predictive value of therapeutic PAP levels, our findings suggest Black and White patients may have comparable PAP alternative responses from a collapsibility standpoint. Future studies should explore reasons for low utilization of PAP alternatives among Black patients.

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Demographic profile of surgical approaches to obstructive sleep apnea in the United States from 2004 to 2020: a descriptive study

Fleury Curado,

Abdelwahab,

Huang

et al. 2024

Sleep Breath

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Objectives This study aims to evaluate the quantity, types, and trends of surgical procedures used to treat obstructive sleep apnea (OSA) within a diverse national population, utilizing a comprehensive proprietary healthcare database. Methods This descriptive observational study analyzed longitudinal data from the Optum Clinformatics® Data Mart databases, covering the period from January 2004 to December 2020. The study included patients aged 18 to 89 years, both male and female, with a confirmed diagnosis of OSA. These patients were either treated with continuous positive airway pressure (CPAP) or underwent surgical interventions. Results Throughout the study period, 1,250,273 individuals were diagnosed with OSA. The average age at diagnosis was 62 years (SD = 16), with a male predominance of 62.3%, and 75% of the patients were identified as Caucasian. The most frequently performed surgical procedure for OSA was Uvulopalatopharyngoplasty (UPPP). However, the implantable hypoglossal nerve stimulator was more commonly utilized among older patients. Conclusions This study provides essential insights into the prevalence and characteristics of surgical procedures used in OSA treatment across a diverse national population. The findings underscore the significance of understanding surgical intervention patterns and trends to enhance patient care and outcomes.

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Racial Disparities in Surgical Treatment of Obstructive Sleep Apnea

Cited by 6 publications

References 56 publications

Sociodemographic and Healthcare System Barriers to PAP Alternatives for Adult OSA: A Scoping Review

Sociodemographic and Healthcare System Barriers to PAP Alternatives for Adult OSA: A Scoping Review

Differences in Positive Airway Pressure Requirements in Obstructive Sleep Apnea Between Black and White Patients

Demographic profile of surgical approaches to obstructive sleep apnea in the United States from 2004 to 2020: a descriptive study

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