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Abstract Introduction Concurrent obstructive sleep apnea (OSA) and insomnia have been reported in cross-sectional studies suggesting that 50% of adults with OSA experienced insomnia symptoms, while 43% of adults with insomnia symptoms had OSA. However, prospective studies reporting associations between these two sleep disorders are uncommon. Therefore, this study sought to examine associations between OSA on subsequent insomnia diagnosis among a diverse cohort of adult women and men. Methods We utilized electronic health records of 1,971,279 patients age 40+y who obtained care at a large US-based medical center. Patients were stratified into three groups based on self-reported race/ethnicity: Whites, Blacks and Arab-Americans. To create the Arab American group, we implemented a name-based algorithm that has been developed and validated to identify Arab ethnicity. Diagnosis of OSA and insomnia based on ICD-10 codes, as well as age at diagnosis were extracted from medical records. Robust (modified) Poisson regression models, adjusting for sex, race/ethnicity, current age, smoking behavior and age at diagnosis for patients with OSA, were utilized to study the association between OSA and insomnia diagnosis. Effect modification by race/ethnicity was also examined. Results The mean age of patients was 66y and over half were women (54%). The cohort was predominately White (87%) and 3% were Arab-Americans. The prevalence of OSA was 4.8%, 5.1% and 3.5% for Whites, Blacks and Arab-Americans, respectively. Overall, patients with OSA were more likely to have insomnia than those without OSA (RR = 6.9, 95% CI: 6.3, 7.5). In addition, we found statistically significant evidence for racial/ethnic differences in the association (p-values for interaction 0.05). Further racial/ethnic-stratified analysis revealed that, the risk of insomnia for OSA patients increased by 11-fold among Arab-Americans (95% CI: 6.5, 19.2), 7-fold among Whites (95% CI: 6.2, 7.5), and 5-fold among Blacks (95% CI: 3.8, 6.9). Conclusion In a large and diverse sample of patients, we found significant positive associations between OSA and insomnia, which were differential among ethnic and racial groups. Arab-Americans with OSA were the most vulnerable to insomnia. These findings suggest ethnic and racial disparities in sleep disorders among Arab-Americans. Support (if any)
Lyu et al. (Sat,) studied this question.