0697 Gender Bias with Centers for Medicare and Medicaid Services Scoring Criteria when Diagnosing Obstructive Sleep Apnea. (12th April 2019)

• Record Type: Journal Article
• Authors: Khalid, Faiza; Ayache, Mirna; Auckley, Dennis
• Is Part Of: Sleep. Volume 42(2019)Supplement 1
• Page Start: A279
• Page End: A280
• Publication Date: 2019-04-12
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsz067.695
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Women with obstructive sleep apnea (OSA) have less hypoxemia during sleep and a lower apnea-hypopnea index (AHI) when compared to men. Therefore, symptomatic women may be less likely than men to meet the Centers for Medicare and Medicaid Services (CMS) criteria for the diagnosis of OSA. We hypothesized that utilizing CMS criteria for diagnosing OSA, as compared to AASM scoring criteria, underestimates the prevalence of OSA in women and precludes symptomatic women from receiving therapy. Methods: We reviewed retrospective data on 741 subjects (219 men and 522 women) who underwent a diagnostic polysomnography at an urban academic sleep center from January to November 2018. Included subjects were >18 years of age and had both a CMS and AASM AHI documented. A univariate logistic regression was performed to evaluate the association between the outcome (CMS score <5 and AASM score ≥5) with three predictors including age, gender and body mass index (BMI). A multivariate logistic regression was then performed to evaluate the association between the outcome and the three predictors in the same model. Results: The mean age and BMI were 50 years and 36 kg/m 2 respectively. Median CMS AHI and Epworth Sleepiness Score were 6.1 and 8 respectively. The odds of CMS scoring criteria missing OSA (CMS AHI <5 and AASM AHI ≥5) in women were twice the odds of a CMS miss in men [OR 2.05, CI 1.45 - 2.88]. The association persisted after including age and BMI, [OR 2.39, CI 1.67-3.43]. When the AASM AHI was included in the logistic regression model, the association with age and BMI became insignificant, but a trend was seen with regard to gender association [OR 1.51, CI 0.97-2.33, p=0.065]. Conclusion: Using CMS scoring criteria, women with an AASM AHI ≥5 were twice more likely than men of comparable age and BMI to not be diagnosed with OSA. This indicates that CMS scoring has a strong gender bias against women and likely prevents a significant number from receiving appropriate treatment. Support (If Any): None