To Sleep, Perchance To Die?

Why sleep apnea is so lethal for Black men, and what can be done about it.

skull and cross bones on alarm clock.

A University at Buffalo study has found that over the past two decades, more Black men have been dying from obstructive sleep apnea than have white people or Black women. And their death rate from sleep apnea continues to rise, in contrast to rates that have flattened for the other two groups.

According to first author Yu-Che Lee, a medical resident in the Jacobs School of Medicine and Biomedical Sciences at UB, this study is the first of its kind. “No study, to our knowledge, has evaluated the disparity of sleep apnea-related mortality among different racial groups,” Lee said.

A dangerous disparity

Sleep apnea is the most common sleep-related breathing disorder and, when untreated, can lead to the development of such deadly diseases as hypertension, heart disease, stroke and diabetes. All of these conditions are common in the Black population.

Lee and his colleagues examined sleep apnea-related mortality rates for the years 1999 to 2019. They found a steady increase in mortality in all groups from 1999 to 2008, but then the rates flattened for Black females and for white males and females. Black males were the only group that saw a continuous increase in mortality for the 21 years of the study.

A way forward?

The flattening of mortality rates in white people and Black females suggests that medical management and public health interventions have helped stabilize their outcomes.

Meanwhile, a combination of factors—including lack of compliance with CPAP (continuous positive airway pressure) machines—likely contribute to the continuing increase in sleep apnea mortality among Black men, the researchers said.

“It is extremely likely that deaths occurred because the subjects were untreated or poorly compliant with therapy,” said M. Jeffery Mador, associate professor in the Department of Medicine in the Jacobs School and a study co-author. “CPAP therapy is highly effective and very few deaths, if any, would be expected if the subjects were adequately treated, followed and were able to use the therapy.”

“Hopefully,” he added, “increasing awareness and improving efficacy of treatment may lead to better health outcomes in this patient population.”