Impact of social vulnerability index on severity of obstructive sleep apnea: Insights from drug-induced sleep endoscopy

Objectives

To examine the association between neighborhood-level social vulnerability on the severity of obstructive sleep apnea (OSA) in patients undergoing drug-induced sleep endoscopy (DISE).

Study design

Single center retrospective cohort study.

Methods

We conducted a retrospective chart review of patients >18 years of age that underwent DISE from July 2016 to July 2022. Patient addresses were geocoded with geographic information systems, and spatial overlays were used to assign census-tract level social vulnerability index (SVI) scores in the four sub-themes: Socioeconomic (theme 1), Household Composition/Disability (theme 2), Minority Status/Language (theme 3), and Housing/Transportation (theme 4).

Results

The study included 165 patients (61.2 years ± 11.6; 31.0 BMI ± 6.1, 102 male, 63 female). Mild OSA was present in13 patients; 55 patients had moderate OSA; and 97 patients had severe OSA. A higher SVI value in minority status and language, and a higher BMI both predicted an increased Apnea Hypopnea Index (AHI) (p = 0.042, and <0.001, respectively) in the multivariate model; whereas, race, age, gender, or the other three SVI sub-theme values were not predictive.

Conclusion

Adults residing in areas of greater social vulnerability – specifically a larger minority presence or English as a second language – and patients who are obese are more likely to have more severe OSA. There was no correlation, however, between obesity and residence in an area of high SVI. These results suggest that both neighborhood conditions and obesity are associated with OSA severity. This elevated risk has potential implications for diagnostic testing, clinic follow-ups, screening, and treatment plans for adults residing in disenfranchised neighborhoods.

Level of evidence

IV.