TOPLINE

Among patients with obstructive sleep apnea (OSA), those living in the most disadvantaged neighborhoods experienced greater sleep-related hypoxemia and had a higher risk for major adverse cardiovascular event (MACE) than those living in the least disadvantaged areas, independent of the frequency of apnea.

METHODOLOGY

• Researchers conducted a retrospective cohort study using data from the Cleveland Clinic sleep registry to assess whether neighborhood socioeconomic disadvantage was associated with more severe OSA and the new-onset of MACE.
• They analyzed 72,443 adults who had not received OSA treatment previously (mean age, 50.4 years; 50.5% men) and undergone diagnostic sleep studies from January 2005 to September 2021; of these, 52,874 underwent polysomnography (PSG) and 19,569 underwent type III sleep testing.
• Neighborhood socioeconomic disadvantage was measured using Area Deprivation Index (ADI) quintiles, ranging from quintile 1 (the least disadvantaged) to quintile 5 (the most disadvantaged).
• OSA-related measures included the apnea-hypopnea index and sleep-related hypoxemia metrics (percentage of sleep time with oxygen saturation < 90% and minimum oxygen saturation).
• The primary outcome was the new-onset of MACE, which was a composite of the first occurrence of cerebrovascular events, heart failure, atrial fibrillation, coronary artery disease, or death. The median follow-up duration was 5.6 years for the PSG cohort and 2.8 years for the type III sleep testing cohort.

TAKEAWAY

• In the PSG cohort, increasing neighborhood deprivation was associated with worse sleep-related hypoxemia: the percentage of sleep time with oxygen saturation < 90% increased and minimum oxygen saturation decreased across ADI quintiles (P < .0001 for both). However, the apnea-hypopnea index did not vary significantly across ADI quintiles.
• In the type III sleep testing cohort, minimum oxygen saturation declined with increasing deprivation (P < .0001), while the apnea-hypopnea index showed no significant trend across ADI quintiles.
• Residence in the most disadvantaged neighborhoods was associated with a 22% higher risk for MACE or death compared with residence in the least disadvantaged neighborhoods in the PSG cohort (adjusted hazard ratio [HR], 1.22; P < .001).
• In the type III sleep testing cohort, compared with ADI quintile 1, ADI quintile 4 (not quintile 5) was associated with a 41% increased risk for MACE or death (adjusted HR, 1.41; P = .0035).

IN PRACTICE

"Incorporating sleep-related hypoxia and socioeconomic disadvantage into cardiovascular risk stratification strategies and healthcare planning may help identify high-risk populations and address disparities in CV [cardiovascular] outcomes," the authors wrote.

SOURCE

The study was led by Cinthya Pena-Orbea, MD, Cleveland Clinic, Cleveland. It was published online on August 31, 2026, in Annals of the American Thoracic Society.

LIMITATIONS

As commonly observed in studies with retrospective designs, this study was susceptible to referral and selection bias. Extrapolation of the findings beyond a clinical referral sample and an Ohio-based population might not be possible. Moreover, the exclusion of patients with prior MACE might further limit generalizability to populations with established cardiovascular disease.

DISCLOSURES

The study was supported by the Neuroscience Transformative Research Resource Development Award and the Center of Population Health Research at Cleveland Clinic. Some authors reported receiving research support from the National Institutes of Health, Department of Defense, and Michael J. Fox Foundation, receiving consulting fees or royalties, and serving on the advisory boards of multiple pharmaceutical companies and medical publishers.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.