Racial disparity in cardiovascular morbidity and mortality associated with obstructive sleep apnea: The sleep heart health study

Abstract

BackgroundAfrican Americans (AA) have higher prevalence of cardiovascular diseases (CVD) and obstructive sleep apnea (OSA) compared to Whites. Previous research demonstrated increased risk of cardiovascular complications from OSA but there is paucity of data about any interaction of race on this effect. Sleep Heart Health Study (SHHS) is a multi-center cohort study that was done to determine the cardiovascular consequences of OSA. Using this data, we assessed the racial disparity of various CVD incidence and mortality between Whites and AA associated with OSA. MethodsWe analyzed data from 5692 participants. Logistic regressions were done to compare the incidence of all CVD and stroke between White and AA. Cumulative death risk from all causes over 13 years were assessed by Cox's proportional hazard model. All models were adjusted for age, BMI, gender, education, hypertension, diabetes, smoking, total sleep time and OSA. ResultsCompared to Whites, AA had higher adjusted odds of developing any CVD (OR = 1.6, 95% CI = 1.19–2.15) and stroke (OR = 1.71, 95 CI = 1.13–2.61). OSA remains an independent risk factor for CVD (OR = 1.15, 96% CI = 1.01–1.47) and stroke (OR = 1.36, 95% CI = 1.04–2.16) after adjusting for race and other covariates. The cumulative adjusted mortality risk was 1.24 times higher in AA than White (95% CI = 1.02–1.51) during this follow up period. Subjects with OSA in highest AHI quartile had 1.35 times (95% CI = 1.13–1.63) higher mortality compared to lowest quartile. ConclusionAA race and untreated OSA are independent predictors for new onset CVD, stroke and higher all-cause mortality, after adjusting for cardiovascular risk factors.