Racial and Ethnic and Sex Differences in At-Home Estimates of Obstructive Sleep Apnea Parameters among Diverse Adults

Rationale: Racial and ethnic and sex differences in sleep may exist, but limited data directly compare objective estimates of obstructive sleep apnea (OSA), particularly in rapid eye movement (REM) versus non-REM (NREM) sleep, among Black, Mexican American and non-Hispanic White (NHW) adults. Objectives: To determine whether OSA parameters during REM and NREM sleep differ by race, ethnicity, or sex in community-dwelling adults. Methods: The DORMIR study conducted a comprehensive sleep examination among Black, Mexican American, and NHW adults 50 years of age and older enrolled in the ongoing HABS-HD (Health and Aging Brain Study-Health Disparities) cohort (2020-2024). Here we characterize racial, ethnic, and sex differences in OSA indices assessed by a U.S. Food and Drug Administration-approved peripheral arterial tonometry-based home sleep testing system. Results: We examined 821 participants (mean age, 66.6 ± 8.5 yr), including 543 (66.1%) women, 284 (34.6%) Mexican American individuals, and 174 (21.2%) Black individuals. About half (50.5%) had moderate to severe OSA as defined by the respiratory event index (REI; based on 3% desaturations of ≥15 events/h), 72.7% with REM-REI ≥ 15 events/h, and 39.5% with NREM-REI ≥ 15 events/h. Significant racial, ethnic, and sex differences were observed for REM-specific but not overall OSA metrics. Black women had the highest REM-REI, and NHW men had the lowest REM-REI. After controlling for demographics, socioeconomic factors, comorbidities, and sleep medication use, Black participants had a REM-REI 3 events/h higher than NHW adults, and NREM-REI values were similar. Mexican American individuals had similar REM or NREM OSA parameters compared with NHW adults but exhibited higher average blood oxygen concentrations. Conclusions: In this new, diverse cohort, peripheral arterial tonometry-based measures of in-home sleep indicate more REM-stage respiratory events in Black adults, particularly Black women, compared with their NHW counterparts. Given the link between REM OSA and adverse health outcomes, clinicians should pay more attention to this sleep apnea phenotype, especially in minoritized populations.