Representation of Race and Sex in Sleep Surgery Studies

Abstract

Objective Obstructive sleep apnea (OSA) is a highly prevalent disorder with many treatment modalities, including surgical intervention. While OSA is known to be more prevalent in males and Black Americans, the representation of race and sex in sleep surgery studies is unknown. The aim of this systematic review is to assess the race and sex demographics represented in sleep surgery studies relative to known OSA demographics. Data Sources PubMed, MEDLINE, and OVID databases. Review Methods A systematic review was conducted to identify studies published between 2016 and 2020 that investigated sleep outcomes following nonnasal surgical intervention for OSA in adults. Pooled racial, ethnic, and sex data of the enrolled subjects in selected studies were analyzed. Results The 148 included studies comprised 13,078 patients. Of the 137 studies that reported sex, 84.0% of participants were male, exceeding the population prevalence of OSA in males, which is estimated at 66%. Only 13 studies reported racial/ethnic demographic data. Of these, 87.8% of patients were White. Out of 30 studies of primarily American patients, only 4 reported race demographic data, with an average of 82.8% White participants. Conclusion There is a racial/ethnic and sex inclusion bias among sleep surgery studies. Future studies should better document the demographics of enrolled participants as well as recruit participants who better represent the demographics of adults with OSA in the general population.

Characteristics of Adults Undergoing Soft Tissue and Orthognathic Surgery for Obstructive Sleep Apnea

“…Despite males comprising a larger portion of our sleep-surgery subset (67.2%), multivariable analysis did not demonstrate an independent association between sex 11,24,25 These trends, along with our data, indicate that, over time, more sleep surgeries have been performed for women. Sleep surgery research often includes primarily male participants 26 ; therefore, it is difficult to extrapolate the results of prior studies to our more diverse sleep surgery population. We identified significant differences in surgery type based on sex, with men being more likely to undergo TR and UPPP and women being more likely to undergo MMA or T & A; however, there was no difference in tonsil or tongue size between women and men.…”

“…These trends, along with our data, indicate that, over time, more sleep surgeries have been performed for women. Sleep surgery research often includes primarily male participants 26 ; therefore, it is difficult to extrapolate the results of prior studies to our more diverse sleep surgery population.…”

Assessment of Variability in Free Flap Color Match to Facial Skin by Donor Site and Race

“…Prior studies have highlighted the overall underreporting of race in otolaryngologic literature, thus limiting the extrapolation of findings to non-White patient populations. 8,9 With known differences in propensity for scarring and hyperpigmentation among individuals with darker-pigmented skin, it is important that we examine the potential sequelae of reconstructive surgeries and aesthetic outcomes with skin tone diversity in mind. 10,11 In this study, we sought to examine how the color match of potential MFTT donor sites to cervicofacial skin varies with race and skin tone.…”

“…It is unclear, however, whether these observations are consistent across the spectrums of racial diversity and skin tone. Prior studies have highlighted the overall underreporting of race in otolaryngologic literature, thus limiting the extrapolation of findings to non‐White patient populations 8,9 . With known differences in propensity for scarring and hyperpigmentation among individuals with darker‐pigmented skin, it is important that we examine the potential sequelae of reconstructive surgeries and aesthetic outcomes with skin tone diversity in mind 10,11 …”