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Race could affect severity of sleep apnea, suggests study

Sleep apnea can lead to many a restless night, and a new study has found that black men with the condition tend to have more severe cases than white men, even after factoring out risk factors like obesity.
Sleep apnea can lead to many a restless night, and a new study has found that black men with the condition tend to have more severe cases than white men, even after factoring out risk factors like obesity.
Kenneth Close/Flickr Creative Commons

Sleep apnea appears to be more common among black men in certain age groups, prompting researchers to conclude that race may affect the severity of the condition.

That's according to a recent study appearing in the Journal of Clinical Sleep Medicine, which said the reason behind the correlation is unclear.

There are two main types of sleep apnea: central and obstructive. The study focused on the latter, which the National Library of Medicine says occurs when a person's airway becomes "narrowed, blocked, or floppy," causing the flow of air to pause or decrease while she or he is asleep:

A person with obstructive sleep apnea usually begins snoring heavily soon after falling asleep. Often the snoring gets louder. The snoring is then interrupted by a long silent period during which there is no breathing. This is followed by a loud snort and gasp, as the person attempts to breathe. This pattern repeats.

Excess alcohol consumption, smoking and possibly family history can all make a person prone to developing sleep apnea, said Dr. Juan Vargas, chief of family medicine at Kaiser Permanente Panorama City Medical Center. Some people also have mechanical blockages – like really large tonsils – that can trigger the condition. But those aren't the biggest risk factors.

"The main one is definitely obesity," he said.

Which is highly prevalent in South Los Angeles. The latest data from the L.A. County Department of Public Health says in South L.A., nearly 1 in 3 adults (about 33 percent) are obese. The county average, on the other hand, is 24 percent.

Socioeconomically speaking, Vargas' patient population in Panorama City is similar to folks in South L.A. Because obesity is more prevalent in areas like those, sleep apnea follows suit, he said. Vargas estimated that every week, out the nearly 100 patients he sees, he sees about three or four patients with apnea symptoms. (That aligns with the National Sleep Foundation's estimate that at least 2 to 3 percent of the population has the condition.) 

"A lack of access to healthy foods, healthy resources, having to work at least one job, sometimes two, puts you at a little bit of a disadvantage because you're not necessarily choosing the healthiest things when you're picking your meals," said Vargas.

Symptoms and treatment

People with sleep apnea often wake up feeling tired or unrefreshed, which comes with its own set of problems, said Vargas.

"That quality of life isn't there," he said. "You're always tired, constantly falling asleep. There is a real risk of falling asleep at the wheel and getting into a car accident." Not to mention the social repercussions: the relationship issues that may come with excessively loud snoring, the irritability, the headaches.

Sleep apnea is treatable, and can usually be completely corrected. Losing weight, avoiding sleeping on one's back and avoiding alcohol and sedatives at bedtime can all help alleviate symptoms. Continuous positive airway pressure (CPAP) is now the first-line treatment for sleep apnea – patients on a CPAP regimen will wear a tight mask over their nose, through which a steady stream of slightly pressurized air is delivered. This helps keeps the windpipe open, and prevents the narrowing of the airway that's characteristic of sleep apnea. But that can be pricey for the uninsured, said Vargas – which isn't an uncommon scenario among low-income populations.

"If it's covered under the insurance, patients don't really pay anything," he said. "But if you were to buy CPAP on the outside" – without insurance – "it would be $300 to $500."

Surgery may also be an option in select cases, but those procedures are expensive, too.

Prevention and the long-term outlook

Vargas said health providers have a long-term goal in treating sleep apnea: preventing more serious, deadly conditions down the road.

"There's a connection between apnea and hypertension and stroke," he said. "In a lot of communities in L.A., South L.A., the Valley, our African-American patients especially are at risk of stroke, and then our Latino patients are at risk of stroke, particularly if you have a family history. Long term, we're trying to prevent people dying from stroke."

The recent Journal of Clinical Sleep Medicine study found that, compared to white men, black men younger than 40 scored higher on the apnea-hypopnea index (AHI), which is used to measure the severity of sleep apnea. The same was true of black men between 50 and 59.

That's not the first time race or ethnicity has been linked to the sleeping disorder. In 2010, the journal SLEEP said based on the available literature and the "high prevalence of obesity, diabetes, substance use, and inner city living" among Latinos, conditions like sleep apnea were "suspected to be high" among the demographic.

Dr. Vargas said it can be hard for a person to self-diagnose themselves with sleep apnea – at his medical center, it's usually the spouse who brings a patient with symptoms in, because she or he can hear her or his partner snoring at night. There's one sign in particular that someone should see a doctor, though.

"The one thing that almost all the patients complain about is they wake up tired," he said. "So they don't feel well-rested after what they consider a normal night of sleep. … If you're still waking up tired, falling asleep easily, and if it's constant where you're trying to stay awake, and you're falling asleep in the couch, the car, at the traffic light – that's something you'll want to come in and talk to a doctor about. Maybe it's something else, but you should feel rested after a decent night of sleep."

In really severe cases, Vargas added, "you'll wake up gasping for air."

Photo by Kenneth Close via Flickr Creative Commons.