2025 American Academy of Neurology Abstract Website

Objective:

Investigate whether the two hypopnea definitions lead to disparities in sleep apnea diagnosis between racial groups.

Background:

The American Academy of Sleep Medicine (AASM) recommends a 3% desaturation or arousal-based scoring of hypopneas while the Centers for Medicare and Medicaid (CMS) use only desaturation criteria. Pulse oximetry is less accurate in people with darker skin tones. We investigated whether CMS guidelines lead to more missed OSA diagnoses in Black compared to White, Hispanic, or Asian people.

Design/Methods:

We reviewed medical records of 1,381 adult patients from BMC who completed a single overnight sleep study from January 2022 to present and collected participant demographics, medical histories, and comorbid diseases diagnoses. Participants self-identified as White (n=468), Black (n=785), Hispanic (n=76) or Asian (n=52). Other racial identifiers were excluded from the analysis. We controlled for age, sex, BMI, anxiety, depression, hypertension, COPD, and smoking status.

Results:

The proportion of participants in each racial group who qualified for an OSA diagnosis using the AASM guidelines but not the CMS guidelines were 0.12 for White participants, 0.1 for Black participants, 0.09 for Hispanic participants, and 0.04 for Asian participants. Chi-squared tests revealed significant differences between diagnoses for guidelines for White (p-value<0.001), Black (p-value<0.001), Hispanic (p-value<0.001) and Asian (p-value<0.001) racial groups. The possibility of a missed OSA diagnosis was not different between racial groups (p-value=0.326). Chi-squared analysis also showed that females were significantly more likely than males to have a missed OSA diagnosis (p-value<0.001).

Conclusions:

The CMS guidelines requiring 4% desaturations to score hypopneas leads to a lower number of OSA diagnoses than when using the 3% arousal-based scoring within all studied groups, but do not discriminate between groups. Females in this study were more likely than males to have missed OSA diagnoses with the 4% criteria, confirming previous observations.