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Symptoms of obstructive sleep apnea in a Caribbean sample

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Abstract

Obstructive sleep apnea (OSA) is a prevalent sleep disorder that disproportionately affects blacks. While clinical and epidemiologic data indicate intraethnic differences in several medical diseases, little is known about whether OSA symptoms differ within the black ethnic group. We estimated the rate of OSA symptoms in a community-based sample of Caribbean-born black men and women. We also ascertained which sociodemographic and/or medical factors were associated with OSA risk. A total of 554 patients (mean age = 48.17 ± 16.75 years) participated in the study; 55% were women. Data were collected in four primary-care clinics in Brooklyn, NY. A health educator explained the purpose of the study to interested patients and assisted consenting participants in completing questionnaires, which required 15 min to complete. Participants reporting habitual snoring, excessive daytime sleepiness, and sleep fragmentation were considered at high OSA risk. The rate of OSA symptoms was: snoring (45%), excessive daytime sleepiness (33%), and difficulty maintaining sleep (34%). Many reported falling asleep while watching television (47%) or while driving (14%). Based on logistic regression analysis, a history of heart disease was the most important predictor of the likelihood of expressing OSA symptoms, with a corresponding multivariate-adjusted odds ratio of 11 (95% confidence interval = 3.03–40.63). Findings suggest the need to investigate whether Caribbean-born blacks are at greater risk for developing OSA than African Americans and whites. Caribbean-born blacks with a history of heart disease should be a prime target for interventions that promote adequate screening and timely OSA diagnosis.

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References

  1. Hudgel DW (1992) Mechanisms of obstructive sleep apnea. Chest 101:541–549

    Article  PubMed  CAS  Google Scholar 

  2. Patil SP, Schneider H, Schwartz AR, Smith PL (2007) Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest 132:325–337

    Article  PubMed  Google Scholar 

  3. Pinto JM, Garpestad E, Weiss JW, Bergau DM, Kirby DA (1993) Hemodynamic changes associated with obstructive sleep apnea followed by arousal in a porcine model. J Appl Physiol 75:1439–1443

    PubMed  CAS  Google Scholar 

  4. Somers VK, Dyken ME, Clary MP, Abboud FM (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 96:1897–1904

    Article  PubMed  CAS  Google Scholar 

  5. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    PubMed  CAS  Google Scholar 

  6. El Ad B, Lavie P (2005) Effect of sleep apnea on cognition and mood. Int Rev Psychiatry 17:277–282

    Article  PubMed  Google Scholar 

  7. Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P (1993) A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest 104:781–787

    Article  PubMed  CAS  Google Scholar 

  8. Kiely JL, McNicholas WT, Zgierska A, Gorecka D, Radzikowska M, Baranowska B, Plywaczewski R, Bednarek M, Przybylowski T, Korczynski P, Zielinski J (2000) Cardiovascular risk factors in patients with obstructive sleep apnoea syndrome [Obstructive sleep apnea and risk factors for coronary artery disease]. Eur Respir J 16:128–133

    Article  PubMed  CAS  Google Scholar 

  9. Wright J, Johns R, Watt I, Melville A, Sheldon T (1997) Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence. BMJ 314:851–860

    PubMed  CAS  Google Scholar 

  10. Findley LJ, Weiss JW, Jabour ER (1991) Drivers with untreated sleep apnea. A cause of death and serious injury. Arch Intern Med 151:1451–1452

    Article  PubMed  CAS  Google Scholar 

  11. Newman AB, Nieto FJ, Guidry U, Lind BK, Redline S, Pickering TG, Quan SF (2001) Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. Am J Epidemiol 154:50–59

    Article  PubMed  CAS  Google Scholar 

  12. Findley LJ, Weiss JW, Jabour ER (1991) Drivers with untreated sleep apnea. A cause of death and serious injury. Arch Intern Med 151:1451–1452

    Article  PubMed  CAS  Google Scholar 

  13. Stoohs RA, Guilleminault C, Itoi A, Dement WC (1994) Traffic accidents in commercial long-haul truck drivers: the influence of sleep-disordered breathing and obesity. Sleep 17:619–623

    PubMed  CAS  Google Scholar 

  14. Lavie P, Herer P, Peled R, Berger I, Yoffe N, Zomer J, Rubin AH (1995) Mortality in sleep apnea patients: a multivariate analysis of risk factors. Sleep 18:149–157

    PubMed  CAS  Google Scholar 

  15. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  PubMed  CAS  Google Scholar 

  16. Hiestand DM, Britz P, Goldman M, Phillips B, Young T, Evans L, Finn L, Palta M (2006) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Chest 130:780–786

    Article  PubMed  Google Scholar 

  17. Young T, Finn L (1998) Epidemiological insights into the public health burden of sleep disordered breathing: sex differences in survival among sleep clinic patients. Thorax 53(Suppl 3):S16–S19

    Article  PubMed  Google Scholar 

  18. Ancoli-Israel S, Klauber MR, Stepnowsky C, Estline E, Chinn A, Fell R (1995) Sleep-disordered breathing in African-American elderly. Am J Respir Crit Care Med 152:1946–1949

    PubMed  CAS  Google Scholar 

  19. Gottlieb DJ, Whitney CW, Bonekat WH, Iber C, James GD, Lebowitz M, Nieto FJ, Rosenberg CE (1999) Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med 159:502–507

    PubMed  CAS  Google Scholar 

  20. Ancoli-Israel S, Klauber MR, Stepnowsky C, Estline E, Chinn A, Fell R (1989) Sleep-disordered breathing in African-American elderly. J Gerontol 44:M18–M21

    PubMed  CAS  Google Scholar 

  21. Redline S, Tishler PV, Hans MG, Tosteson TD, Strohl KP, Spry K (1997) Racial differences in sleep-disordered breathing in African-Americans and Caucasians. Am J Respir Crit Care Med 155:186–192

    PubMed  CAS  Google Scholar 

  22. Redline S, Tishler P, Hans M, Tosteson T, Strohl K, Spry K (1997) Racial differences in sleep-disordered breathing in African-Americans and Caucasians. Am J Respir Crit Care Med 155:186–192

    PubMed  CAS  Google Scholar 

  23. Buxbaum SG, Elston RC, Tishler PV, Redline S (2002) Genetics of the apnea hypopnea index in Caucasians and African Americans: I. Segregation analysis. Genet Epidemiol 22:243–253

    Article  PubMed  Google Scholar 

  24. Flack JM, Amaro H, Jenkins W, Kunitz S, Levy J, Mixon M, Yu E (1995) Epidemiology of minority health. Health Psychol 14:592–600

    Article  PubMed  CAS  Google Scholar 

  25. Mayberry RM, Mili F, Ofili E (2000) Racial and ethnic differences in access to medical care. Med Care Res Rev 57(Suppl 1):108–145

    Article  PubMed  Google Scholar 

  26. Penn NE, Kar S, Kramer J, Skinner J, Zambrana RE (1995) Ethnic minorities, health care systems, and behavior. Health Psychol 14:641–646

    Article  PubMed  CAS  Google Scholar 

  27. Jean-Louis G, Zizi F, Casimir G, Compas J (2007) Sleep in America: is race or culture an important factor? In: Leger D, Pandi-Perumal SR (eds) Sleep disorders: their impact on public health. Taylor & Francis, Oxford, UK, pp 37–39

    Google Scholar 

  28. Jean-Louis G, Magai C, Cohen CI, Zizi F, von Gizycki H, DiPalma J, Casimir G (2001) Ethnic differences in reported sleep problems in older adults. Sleep 24:926–933

    PubMed  CAS  Google Scholar 

  29. Jean-Louis G, Magai C, Casimir GJ, Zizi F, Moise F, McKenzie D et al (2008) Insomnia symptoms in a multiethnic sample of American women. J Women’s Health 17:15–25

    Article  Google Scholar 

  30. Fang J, Madhavan S, Alderman MH (1996) The association between birthplace and mortality from cardiovascular causes among black and white residents of New York City. N Engl J Med 335:1545–1551

    Article  PubMed  CAS  Google Scholar 

  31. Frieden T (2006) The health of immigrants in New York City: a report from the New York City Department of Health and Mental Hygiene. New York City Department of Health and Mental Hygiene, New York, pp 1–27

    Google Scholar 

  32. O’Connor GT, Lind BK, Lee ET, Nieto FJ, Redline S, Samet JM, Boland LL, Walsleben JA, Foster GL (2003) Variation in symptoms of sleep-disordered breathing with race and ethnicity: the Sleep Heart Health Study. Sleep 26:74–79

    PubMed  Google Scholar 

  33. Kalra M, Bernstein D, Daftary A, Kalra H, LeMasters G (2005) Prevalence of snoring among young adult females with atopy. Chest 128:224S

    Article  Google Scholar 

  34. Durrence HH, Lichstein KL (2006) The sleep of African Americans: a comparative review. Behav Sleep Med 4:29–44

    Article  PubMed  Google Scholar 

  35. Friedman M, Bliznikas D, Klein M, Duggal P, Somenek M, Joseph NJ (2006) Comparison of the incidences of obstructive sleep apnea–hypopnea syndrome in African-Americans versus Caucasian-Americans. Otolaryngol Head Neck Surg 134:545–550

    Article  PubMed  Google Scholar 

  36. National Sleep Foundation (2005) Omnibus sleep in America poll. National Sleep Foundation, Washington, DC, pp 1–51

    Google Scholar 

  37. Enright PL, Newman AB, Wahl PW, Manolio TA, Haponik EF, Boyle PJ (1996) Prevalence and correlates of snoring and observed apneas in 5,201 older adults. Sleep 19:531–538

    PubMed  CAS  Google Scholar 

  38. Teculescu D, Benamghar L, Hannhart B, Montaut-Verient B, Michaely JP (2007) Habitual snoring. Prevalence and risk factors in a sample of the French male population. Rev Mal Respir 24:281–287

    PubMed  CAS  Google Scholar 

  39. Ohayon MM, Guilleminault C, Priest RG, Caulet M (1997) Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom population sample. BMJ 314:860–863 [see comments]

    PubMed  CAS  Google Scholar 

  40. Lindberg E, Taube A, Janson C, Gislason T, Svardsudd K, Boman G (1998) A 10-year follow-up of snoring in men. Chest 114:1048–1055

    Article  PubMed  CAS  Google Scholar 

  41. Ng TP, Seow A, Tan WC (1998) Prevalence of snoring and sleep breathing-related disorders in Chinese, Malay and Indian adults in Singapore. Eur Respir J 12:198–203

    Article  PubMed  CAS  Google Scholar 

  42. Soldatos CR, Allaert FA, Ohta T, Dikeos DG (2005) How do individuals sleep around the world? Results from a single-day survey in ten countries. Sleep Med 6:5–13

    Article  PubMed  Google Scholar 

  43. Ohayon MM, Caulet M, Philip P, Guilleminault C, Priest RG (1997) How sleep and mental disorders are related to complaints of daytime sleepiness. Arch Intern Med 157:2645–2652

    Article  PubMed  CAS  Google Scholar 

  44. Qureshi AI, Giles WH, Croft JB, Bliwise DL (1997) Habitual sleep patterns and risk for stroke and coronary heart disease: a 10-year follow-up from NHANES I. Neurology 48:904–911

    PubMed  CAS  Google Scholar 

  45. Giles DE, Perlis ML, Reynolds CF, Kupfer DJ (1998) EEG sleep in African-American patients with major depression: a historical case control study. Depress Anxiety 8:58–64

    Article  PubMed  CAS  Google Scholar 

  46. Hwu HG, Yeh EK, Chang LY (1989) Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule. Acta Psychiatr Scand 79:136–147

    Article  PubMed  CAS  Google Scholar 

  47. Poland RE, Rao U, Lutchmansingh P, McCracken JT, Lesser IM, Edwards C, Ott GE, Lin KM (1999) REM sleep in depression is influenced by ethnicity. Psychiatry Res 88:95–105

    Article  PubMed  CAS  Google Scholar 

  48. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 51:8–19

    PubMed  CAS  Google Scholar 

  49. Briones B, Adams N, Strauss M, Rosenberg C, Whalen C, Carskadon M, Roebuck T, Winters M, Redline S (1996) Relationship between sleepiness and general health status. Sleep 19:583–588

    PubMed  CAS  Google Scholar 

  50. kleinman A (1981) Culture and patient care: psychiatry among the Chinese. Drug Therapy 11:134–140

    Google Scholar 

  51. Bousquet J, Khaltaev N (2007) Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. World Health Organization, Geneva, pp 1–146

    Google Scholar 

  52. Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, Sahadevan J, Redline S (2006) Association of nocturnal arrhythmias with sleep-disordered breathing: the Sleep Heart Health Study. Am J Respir Crit Care Med 173:910–916

    Article  PubMed  Google Scholar 

  53. The National Commission on Sleep Disorders Research (1993) Wake up America: a national sleep alert. US Government Printing Office, Washington DC

    Google Scholar 

  54. Ball EM, Simon RD Jr., Tall AA, Banks MB, Nino-Murcia G, Dement WC (1997) Diagnosis and treatment of sleep apnea within the community. The Walla Walla Project. Arch Intern Med 157:419–424

    Article  PubMed  CAS  Google Scholar 

  55. Bahammam A, Kryger M (1999) Decision making in obstructive sleep-disordered breathing: putting it all together. Otolaryngol Clin North Am 32:333–348

    Article  PubMed  Google Scholar 

  56. Chung SA, Jairam S, Hussain MR, Shapiro CM (2001) Knowledge of sleep apnea in a sample grouping of primary care physicians. Sleep Breath 5:115–121

    Article  PubMed  CAS  Google Scholar 

  57. Silverberg DS, Oksenberg A, Iaina A (1997) Sleep related breathing disorders are common contributing factors to the production of essential hypertension but are neglected, underdiagnosed, and undertreated. Am J Hypertens 10:1319–1325

    PubMed  CAS  Google Scholar 

  58. Kramer NR, Cook TE, Carlisle CC, Corwin RW, Millman RP (1999) The role of the primary care physician in recognizing obstructive sleep apnea. Arch Intern Med 159:965–968

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Funding from NIH (1R24MD001090 and HL085042) supported this work.

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Authors and Affiliations

  1. Brooklyn Center for Health Disparities, Division of Cardiovascular Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Ferdinand Zizi, Girardin Jean-Louis, Sonalis Fernandez, Jason M. Lazar & Clinton D. Brown

  2. Sleep Disorders Center, Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Ferdinand Zizi & Girardin Jean-Louis

  3. Department of Ophthalmology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 58, Brooklyn, NY, USA

    Ferdinand Zizi & Girardin Jean-Louis

  4. Brooklyn Research Foundation on Minority Health, Kingsbrook Jewish Medical Center, Brooklyn, NY, USA

    Ferdinand Zizi, Girardin Jean-Louis & Joao Nunes

  5. Department of Scientific Computing, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Hans von Gizycki

  6. Sophie Davis School of Biomedical Education, City College New York, New York, NY, USA

    Joao Nunes

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  1. Ferdinand Zizi
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  2. Girardin Jean-Louis
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Correspondence to Girardin Jean-Louis.

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Zizi, F., Jean-Louis, G., Fernandez, S. et al. Symptoms of obstructive sleep apnea in a Caribbean sample. Sleep Breath 12, 317–322 (2008). https://doi.org/10.1007/s11325-008-0190-x

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  • DOI: https://doi.org/10.1007/s11325-008-0190-x

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