The Caribbean island nation of Grenada is facing a growing public health emergency of non-communicable diseases (NCDs), and a critical contributing factor has long flown under the radar of clinical care and public health planning: undiagnosed obstructive sleep apnea (OSA).
For anyone walking through a local health center in Grenada, the prevalence of two of the most common NCDs — hypertension and type 2 diabetes — is immediately apparent. At Grenada General Hospital, the devastating long-term outcomes of uncontrolled conditions are on full display: patients recovering from strokes, living with heart disease, or undergoing dialysis to treat kidney failure. What makes these outcomes particularly frustrating for clinicians is that many patients have already taken the recommended steps: they follow medication regimens, adjust their diets, and modify other daily habits, yet their blood pressure continues to rise, and their blood sugar levels remain unregulated.
The national statistics paint an alarming picture of the NCD crisis for the 120,000 residents of the so-called Spice Isle. Data from the 2012 Grenada Heart Project shows that 57.7% of the population is overweight or obese, 29.7% live with hypertension, and 13.3% have been diagnosed with diabetes. A 2022 progress monitoring report from the World Health Organization (WHO) adds more context: 83% of all deaths in Grenada are caused by NCDs, and 23% of people will die prematurely from one of these chronic conditions. The human and economic toll is devastating, with families reeling from the financial and emotional stress of caring for a loved one after a stroke, and many patients facing amputation due to complications from unmanaged diabetes.
A recent joint review conducted by the World Bank and Grenada’s Ministry of Health, Wellness and Religious Affairs analyzed patient medical records across the country and confirmed what local clinicians have observed: at least 40% of patients undergoing treatment for hypertension or diabetes still do not have their conditions under control. The review identified several common barriers to effective management: gaps in patient health education, inconsistent clinical care standards, frequent medication shortages, and widespread preference for traditional herbal remedies over conventional medical treatment. However, the review failed to address one critical, understudied factor that may be driving poor outcomes: sleep health.
No analysis was done of patients’ sleep quality, the prevalence of OSA, or the possibility that nocturnal sleep disturbances are quietly undermining all the clinical work done to manage chronic conditions during the day. OSA is a chronic physiological condition in which the upper airway partially or fully collapses repeatedly during sleep, setting off a chain of harmful biological responses. People living with untreated OSA experience persistent overnight elevated blood pressure, chronic systemic inflammation, and disruption of critical hormonal balances. Beyond these internal effects, OSA leaves patients waking up exhausted and unrefreshed, cutting into daily productivity and increasing the risk of car accidents due to drowsy driving. The single largest modifiable risk factor for OSA is obesity, meaning Grenada’s already widespread obesity epidemic is almost certainly driving a parallel, unrecognized growth in OSA rates across the country.
Rigorous clinical research already supports the link between OSA and uncontrolled chronic disease. The Jackson Heart Sleep Study, a landmark investigation focused exclusively on African American participants, found that people with moderate to severe OSA were twice as likely to develop resistant hypertension — defined as blood pressure that remains above 130/80 mmHg even when a patient takes three or more different hypertension medications. This finding is particularly relevant to Grenada’s public health context, where 40% of treated hypertension patients still fail to hit their blood pressure targets. The study’s results raise a pressing clinical question: how many patients are being prescribed additional, unnecessary blood pressure medication when the root cause of their uncontrolled condition is actually undiagnosed OSA that requires sleep testing and targeted treatment?
The racial and ancestral context of this crisis also cannot be ignored. The vast majority of Grenada’s population traces their ancestry to West Africa, and existing research confirms that people of African descent face a disproportionately high burden of OSA and its related cardiovascular complications. While most of this research has been conducted in the United States, the biological links hold across geographic boundaries. Early regional research in the Caribbean already supports this conclusion: a groundbreaking study conducted in Haiti found that nearly three-quarters of participants reported excessive daytime sleepiness, the most common hallmark symptom of OSA. These preliminary results make clear that more regional research is urgently needed to map the true prevalence of sleep disorders across Caribbean nations.
OSA is a treatable condition, but it has been overlooked for decades, even as it contributes to the chronic disease burden that is overwhelming Grenada’s health system. Broadly speaking, healthy sleep is not an optional luxury — it is a foundational requirement for the body’s daily repair and restoration processes. A growing body of global research has confirmed the direct links between untreated OSA and hypertension, type 2 diabetes, and heart disease, making increased awareness among both clinicians and patients an urgent public health priority. For Grenada, as it works to turn the tide on its growing NCD crisis, one of the most impactful first steps toward better population health may turn out to be as simple, and as transformative, as helping more patients get a healthy night of sleep.
This commentary was written by Dr. Kamilah Spencer, a board-certified Sleep Medicine and Internal Medicine physician who is developing a virtual medical practice to serve patients across the Caribbean.