Obstructive sleep apnea underdiagnosis: Prevalence and correlates from the Sleep Health and Knowledge in US Hispanics study.
Level 4 - case-series / case-control
Cross-sectional observational study assessing correlates of undiagnosed obstructive sleep apnea
PubMed 42548906 · doi:10.1093/sleepadvances/zpag071
What was done
Researchers evaluated 156 adults (mean age 56.3 years; 33% female; 49% Hispanic of Mexican descent, 51% non-Hispanic white) in San Diego, CA, who met criteria for moderate-to-severe obstructive sleep apnea (OSA; apnea-hypopnea index [AHI] ≥ 15 events/h with ≥ 3% oxygen desaturation on overnight home polysomnography). Participants completed surveys on prior medical and OSA diagnoses, the Epworth Sleepiness Scale, the Short Acculturation Scale for Hispanics, and demographic/anthropometric measures. Bivariate and adjusted logistic regressions tested factors associated with having undiagnosed versus diagnosed OSA.
What was found
Among participants with confirmed moderate-to-severe OSA, 81.4% were undiagnosed (85.5% in Hispanic participants vs. 77.5% in non-Hispanic white participants; difference was not statistically significant). Independent correlates of underdiagnosis included having no prior diagnosis of high blood pressure (OR = 3.44, p = .005) and lower AHI values (OR = 1.02, p = .030). Age, gender, ethnicity, education, body mass index, daytime sleepiness, acculturation, and diabetes history showed no statistically significant association with underdiagnosis.
Why it matters
Even moderate-to-severe sleep apnea remains broadly unrecognized across ethnic groups in community settings, particularly among individuals lacking classic cardiovascular comorbidities like hypertension or those with relatively lower disease severity.
Limits
The sample size was modest (n = 156) and restricted to a single geographic area (San Diego, CA) and two ethnic groups, limiting generalizability. OSA history relied on self-report, and the cross-sectional design cannot establish causality or determine clinical care pathways.