Background: Racial and ethnic and sex differences in sleep may exist, but there are limited data directly comparing objective estimates of sleep-disordered breathing (SDB), particularly in rapid eye movement (REM) versus non-rapid eye movement (NREM) sleep, among Black, Mexican American (MA) and non-Hispanic White (NHW) men and women. Our goal is to investigate health disparities in SDB in a new, diverse cohort of older adults. Research Question: Do SDB parameters during REM and NREM sleep differ by race and ethnicity or sex in community-dwelling older adults? Methods: The Dormir Study conducted a comprehensive sleep examination among eligible participants enrolled in the ongoing community-based Health and Aging Brain Study- Health Disparities (HABS-HD) cohort (2020-4), among Black, MA, and NHW adults aged 50 years and older. Here we characterize racial and ethnic and sex differences in SDB indices assessed by an FDA-approved Peripheral Arterial Tonometry (PAT)-based home sleep testing system. Results: We examined 821 participants, including 543 (66.1%) women, and 284 (34.6%) MA and 174 (21.2%) Black individuals, with a mean (SD) age of 66.6 (8.5) years. Around half (50.5%) of the participants had moderate to severe SDB as defined by the respiratory event index (REI based on 3% desaturations) of at least 15/hour, 72.7% with moderate to severe REM SDB (REM-REI = 15/hour or higher) and 39.5% with moderate to severe NREM SDB (NREM-REI = 15/hour or higher). The prevalence of SDB did not differ by race or sex. However, significant racial and ethnic and sex differences were observed for REM-specific SDB metrics. Overall, Black women had the highest REM REI, and NHW men had the lowest REM REI and REM ODI. After controlling for age, sex, education, income, employment status, cognitive status, BMI, history of hypertension, diabetes, stroke, and coronary heart disease, and sleep medication use, Black participants had a REM-REI that was 3 events per hour higher than that of NHW adults, while NREM-REI were similar. MA individuals had similar REM or NREM SDB parameters compared to NHW adults but exhibited higher average blood oxygen levels. Conclusions: In this community-based cohort of middle- to older-aged NHW, MA, and Black adults, PAT-based measures of in-home sleep indicate a higher prevalence of REM SDB in Black adults, particularly Black women, compared to their NHW counterparts; this contrasts with the similar NREM parameters observed across racial and ethnic groups. Given the close link between REM SDB and adverse health outcomes, clinicians should pay more attention to this sleep apnea phenotype, especially in minoritized populations.

The authors have declared no competing interest.

The Dormir study is supported by the NIA R01AG066137. The HABS-HD study was supported by the NIA R01AG054073, R01AG058533, and U19AG078109. This work is also supported by NIA R01AG083836 (PI: Yue Leng).

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The North Texas Regional Institutional Review Board gave ethical approval for this work (1516500-1).

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