Link Between Obstructive Sleep Apnea and Incident Stroke in Black Americans

(HealthDay News) — Among White individuals, obstructive sleep apnea (OSA), provider-diagnosed sleep apnea (PDSA), and use of positive airway pressure (PAP) for treatment of PDSA are associated with an increased risk for incident stroke, according to a study published online March 6 in Neurology.

Rebecca Robbins, Ph.D., from Harvard Medical School in Boston, and colleagues examined OSA symptoms and their relationships to stroke incidence by race/ethnicity using data from the Reasons for Geographic and Racial Differences in Stroke study. The relationship of snoring, OSA risk, PDSA, and PDSA treatment using PAP with incident stroke was examined during an average of 12 years of follow-up.

Overall, 38.1 percent of the 22,192 participants identified as Black. The researchers found that snoring was not associated with incident stroke. Among White, but not Black individuals, there were associations seen for high OSA risk and PDSA with incident stroke. In White individuals, PAP therapy among those with PDSA was associated with increased incident stroke risk; among Blacks, PAP therapy use was associated with a reduced risk for incident stroke among those with PDSA.

“We also document a concerning increase in incident stroke risk among White individuals with PDSA who reported PAP therapy use compared with those without PDSA, but a reduction in stroke risk among Black individuals with PDSA who reported PAP therapy use compared with those with PDSA not using PAP therapy, thereby complicating and refining the previous literature on racial/ethnic disparities in OSA symptoms, risk, and treatment,” the authors write.

One author disclosed ties to industry.

Related: Sleep Apnea Linked to Heart Failure in Cancer Patients

What is obstructive sleep apnea (OSA)?

Obstructive sleep apnea (OSA) is a common and potentially serious sleep disorder characterized by repeated interruptions in breathing during sleep. These interruptions, known as apneas, happen when the upper airway becomes partially or completely blocked, causing an airflow decrease or breathing to stop temporarily. This breathing disruption can happen multiple times throughout the night, causing fragmented sleep and various health issues if untreated.

The main cause of obstructive sleep apnea is throat muscle relaxation while sleeping, allowing soft tissue to collapse and block the airway. Contributing factors to this relaxation and later obstruction include excess bodyweight, anatomical abnormalities in the throat or jaw, enlarged tonsils or adenoids, and nasal congestion. Additionally, certain lifestyle habits such as smoking, excessive alcohol consumption, and sedative use can exacerbate the condition.

The hallmark symptoms of obstructive sleep apnea include loud snoring, choking or gasping during sleep, and daytime sleepiness or fatigue despite adequate time spent in bed. Other symptoms may include morning headaches, irritability, difficulty concentrating, and decreased libido. However, not everyone with OSA experiences noticeable symptoms, making it essential for individuals at risk to undergo evaluation and testing for proper diagnosis.

Related: Black Stroke Survivors Less Likely to Get Treated for Complications

Why do so many Black Americans deal with OSA?

Several factors contribute to the higher prevalence of obstructive sleep apnea (OSA) among Black Americans compared to other racial or ethnic groups. These factors often intersect with social determinants of health, genetic predispositions, and lifestyle factors.

Some studies suggest that anatomical differences in the upper airway, such as narrower airways and differences in soft tissue anatomy, may contribute to a higher risk of OSA among Black individuals. These anatomical variations can increase susceptibility to airway obstruction during sleep.

Obesity is also a significant risk factor for OSA, and Black Americans have higher rates of obesity compared to other racial or ethnic groups in the United States. Excess weight, particularly visceral fat around the neck and throat, can contribute to airway obstruction during sleep.

Environmental factors such as exposure to air pollution, allergens, and secondhand smoke may also contribute to the development or exacerbation of OSA among Black Americans.

Addressing the disparities in OSA prevalence among Black Americans requires a multifaceted approach that addresses both individual and systemic factors.

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