Obstructive Sleep Apnea Underdiagnosis: Prevalence and Correlates from the Sleep Health and Knowledge in US Hispanics Study

Abstract Study Objectives To examine the prevalence of obstructive sleep apnea (OSA) underdiagnosis and sociodemographic, behavioral, and medical correlates of underdiagnosis among Hispanic participants of Mexican descent and non-Hispanic white participants in San Diego, CA. Methods Participants underwent overnight home polysomnography (PSG) and were eligible for the study if they met OSA diagnostic criteria at an apnea-hypopnea index (AHI) ≥ 15/hour, minimum 3% oxygen desaturation. Participants self-reported their medical history including past OSA diagnosis, demographics, anthropometrics, and completed the Epworth Sleepiness Scale, and the Short Acculturation Scale for Hispanics. Logistic regressions were used to test bivariate and adjusted associations of correlates with OSA diagnosis status (diagnosed or undiagnosed). Results Participants (N = 156) had mean (SD) age = 56.3 (15.1) years, 33% were female, and 9% were Hispanic. In this sample with AHI ≥ 15/hour, 81.4% had undiagnosed OSA (85.5% among the Hispanic participants of Mexican descent, 77.5% among the non-Hispanic white participants, not statistically significant difference). No prior high blood pressure diagnosis (OR = 3.44, p = .005) and lower AHI (OR = 1.02, p = .030) were associated with increased likelihood of underdiagnosis. Age, gender, ethnicity, education, BMI, daytime sleepiness, acculturation, and diabetes diagnosis were not associated with underdiagnosis. Conclusions Most participants with moderate to severe OSA by home PSG were undiagnosed, regardless of their ethnicity. A lower AHI and no prior diagnosis of high blood pressure were associated with greater OSA underdiagnosis. Enhanced OSA screening, across groups, is needed to reach the large majority that are missed.