Underestimation of OSA in Black Patients Due to Measurement Error

Core Concepts

Measurement error may lead to underestimating obstructive sleep apnea severity in Black patients compared to White patients.

Abstract

The content discusses how measurement error may be responsible for underdiagnosing obstructive sleep apnea (OSA) in Black patients compared to White patients. Data from nearly 2,000 individuals, including ICU patients during the COVID-19 pandemic, suggests that pulse oximetry devices used to measure oxygen saturation may be less accurate for patients with darker skin. The study presented at the ATS annual meeting analyzed data from 1955 adults enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA) Exam 5. The research found that desaturation sensitivity was significantly lower in Black patients compared to White patients, potentially leading to an underestimation of OSA severity in Black individuals.

Key Highlights:

• Measurement error may contribute to underdiagnosing OSA in Black patients.
• Data from ICU patients during the COVID-19 pandemic indicates pulse oximetry devices may be less accurate for patients with darker skin.
• Desaturation sensitivity was lower in Black patients compared to White patients, potentially affecting OSA severity assessment.

Stats

Apnea hypopnea index (AHI3P) was similar between Black and White patients, at approximately 19 events per hour.
Desaturation sensitivity was significantly lower in Black patients and Asian patients compared with White patients (P < .001 and P < .02, respectively).

Quotes

"We may be underestimating OSA severity in Blacks, especially in Black women." - Ali Azarbarzin

Key Insights Distilled From

Standard Measure May Underestimate OSA in Black Patients

by Heidi Splete at www.medscape.com 05-24-2023

https://www.medscape.com/viewarticle/992387

Deeper Inquiries

How can healthcare providers address the potential impact of measurement error on OSA diagnosis in Black patients?

Healthcare providers can address the potential impact of measurement error on OSA diagnosis in Black patients by first acknowledging the disparities that exist in diagnostic accuracy based on skin tone. Providers should be educated on the limitations of pulse oximetry devices in accurately measuring oxygen saturation in individuals with darker skin tones. It is crucial for healthcare professionals to be aware of these potential biases and actively work towards mitigating them by considering alternative diagnostic methods or adjusting interpretation criteria for OSA in Black patients. Additionally, increasing diversity in clinical trials and research studies can help uncover and address these disparities in diagnostic accuracy.

What steps can be taken to improve the accuracy of OSA severity assessment in individuals with darker skin tones?

To improve the accuracy of OSA severity assessment in individuals with darker skin tones, several steps can be taken. Firstly, healthcare providers should consider using alternative diagnostic tools or methods that are less affected by skin pigmentation, such as home sleep apnea tests or in-lab polysomnography with additional monitoring parameters. Additionally, increasing awareness among healthcare professionals about the potential impact of skin tone on measurement accuracy can lead to more cautious interpretation of results and consideration of individual patient characteristics. Research and development of new technologies specifically designed to account for variations in skin pigmentation can also help improve the accuracy of OSA severity assessment in individuals with darker skin tones.

How can the findings of this study influence the development of more inclusive diagnostic tools for sleep disorders?

The findings of this study can influence the development of more inclusive diagnostic tools for sleep disorders by highlighting the importance of considering racial and ethnic diversity in the design and validation of diagnostic devices. Researchers and developers should prioritize inclusivity in clinical studies and trials to ensure that diagnostic tools are effective across different skin tones and ethnicities. Collaboration between healthcare providers, researchers, and technology developers can lead to the creation of more accurate and reliable diagnostic tools that account for variations in skin pigmentation. By incorporating the insights from this study, future diagnostic tools for sleep disorders can be more inclusive and provide equitable healthcare outcomes for all patients.