New research suggests that current screening methods for diagnosing sleep apnea may put Black patients at a disadvantage. Obstructive sleep apnea (OSA) is a serious sleep disorder characterized by disrupted breathing during sleep. An initial screening tool might be an overnight pulse oximeter test – a small device clipped onto a fingertip that measures blood oxygen levels. However, investigators began this study after seeing research that pulse oximeters used on intensive care unit patients during the COVID-19 pandemic might be less accurate in Black patients than in white patients.

“We hypothesized that this would be the case,” said study co-author Ali Azarbarzin, an assistant professor of medicine at Harvard Medical School, in Boston. The researchers examined the results of almost 2,000 patients of varying races and ethnicities who did overnight home sleep studies. The investigators compared participants’ average change in oxygen levels after each breathing pause using equipment that included oximeters.

The team found that Black participants had a smaller decrease in oxygen saturation – blood oxygen level – for each breathing pause compared to white patients. This was true after accounting for other factors that can influence blood oxygen levels, including age, sex, body mass index (a measurement based on weight and height), and smoking.

“Our findings suggest that these measurement problems may lead to underestimation of the severity of OSA in Black individuals. However, whether this underestimation of oxygen drops should lead to important differences in diagnosing and managing OSA in Black and other individuals with dark skin is unclear,” Azarbarzin said.

“Nonetheless, these findings highlight the need to rigorously test the accuracy of oximeters across diverse populations and also to consider whether factors other than the oximeter’s characteristics could explain differences in oxygen patterns with breathing pauses,” he added.

The findings were presented at the annual meeting of the American Thoracic Society, in Washington, D.C. Research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

OSA is a common sleep disorder that affects millions of people worldwide. It is characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep, leading to decreased oxygen levels and disrupted sleep patterns. OSA is associated with a range of health problems, including high blood pressure, heart disease, stroke, and diabetes.

Diagnosis of OSA typically involves a sleep study, which can be done in a sleep laboratory or at home. During the study, various physiological parameters are monitored, including breathing patterns, oxygen levels, and brain activity. Treatment options for OSA include lifestyle changes, such as weight loss and exercise, as well as medical devices, such as continuous positive airway pressure (CPAP) machines and oral appliances. In some cases, surgery may be necessary to correct anatomical abnormalities that contribute to OSA.

In conclusion, the accuracy of screening methods for diagnosing sleep apnea needs to be rigorously tested across diverse populations. The findings of this study suggest that current screening methods may underestimate the severity of OSA in Black individuals. However, further research is needed to determine whether this underestimation should lead to important differences in diagnosing and managing OSA in Black and other individuals with dark skin.

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