Racial and Ethnic Disparities in the Diagnosis and Treatment of Obstructive Sleep Apnea: A Systematic Review

Background: Sleep apnea is identified and treated less frequently among racial and ethnic minorities. Objective: The purpose of this systematic review was to examine disparities among racial and ethnic minorities and to understand the reasons for poor sleep health. Methods: The authors conducted a literature search using PubMed and Cochrane Library databases, last accessed in September 2025, using regular and MeSH keywords. A total of 123 articles were identified. PRISMA guidelines were followed, the PICO framework was applied, and the inclusion criteria were based on studies conducted in the past 10 years. After quality assessment, 18 studies were included for in-depth analysis. Results: The 18 studies included meta-analyses and observational cohort studies. In total, 51,489 patients were represented. Studies revealed that sleep apnea is underdiagnosed and undertreated in ethnic minority populations. Resident location, gender, economic status, and marital status also play an important role. One study noted clinically insignificant differences in positive airway pressure requirements between black and white populations. Nocturnal hypertension and increased left ventricle size are also observed in untreated sleep apnea. Given the heterogenous nature of the studies, quality risk assessment was not possible, which is a limitation of this study. Conclusions: Sleep apnea is underdiagnosed and undertreated among ethnic minorities. Factors such as ancestry, comorbidities, social determinants, geography, and healthcare access drive global inequities. Further sleep apnea phenotyping may be of value in planning treatment strategies.