by Dr Kamilah Spencer, Sleep Medicine & Internal Medicine Physician
Walk into any health centre in Grenada and the odds are that the person sitting next to you has either high blood pressure or diabetes mellitus type 2 (diabetes).
Visit the Grenada General Hospital, and the long-term consequences of these diseases are palpable: patients suffering from a stroke, heart disease, or potentially on dialysis. Many patients have made genuine efforts to adjust their lifestyle by being compliant with medications and improving their diet. Yet the “pressure only gets higher” and the blood sugar “sweeter”.
As it relates to high blood pressure and diabetes, most Grenadians either live with one of these conditions or know someone who does. For the Spice Isle of the Caribbean, a country of roughly 120,000 people, the data is alarming. The 2012 Grenada Heart Project found that 57.7% of the population was overweight or obese, 29.7% had hypertension, and 13.3% had diabetes. According to the World Health Organisation (WHO) 2022 progress monitor report, 83% of deaths in Grenada are caused by non-communicable diseases (NCDs), and the probability of premature death from an NCD is 23%. The human cost is visible in families absorbing the financial and emotional impact of a stroke and in patients losing limbs to poorly controlled diabetes.
The World Bank, in collaboration with the Ministry of Health, Wellness and Religious Affairs of Grenada, reviewed medical records across the country and found that at least 40% of patients receiving treatment for hypertension or diabetes were not achieving control. Numerous reasons were identified, including gaps in patient education, inconsistent standards of care, medications being out of stock, and a preference for traditional remedies. Yet one critical factor was missing from the discussion: Sleep. The review did not examine sleep quality, the prevalence of obstructive sleep apnea (OSA), or the possibility that what happens at night may be quietly undermining everything clinicians work to manage during the day.
OSA is a medical condition where the airway partially or completely collapses during sleep, triggering a cascade of physiological consequences. Persons with OSA experience elevations in blood pressure, chronic inflammation, and hormonal disruption. Beyond these effects, patients wake fatigued and unrefreshed compromising both productivity and their safety behind the wheel. One of the most significant risk factors for OSA is obesity, which means Grenada’s obesity epidemic and its sleep apnea burden are almost certainly growing together, largely unseen.
The clinical evidence is substantial. The Jackson Heart Sleep Study, conducted exclusively in African Americans, found that moderate to severe sleep apnea was associated with twice the odds of resistant hypertension. In this study, resistant hypertension was defined as blood pressure above 130/80 despite the use of three or more medications. These findings are especially relevant in Grenada, where 40% of patients receiving treatment for hypertension are still not achieving control. Taken together, the evidence raises an important question: how many patients are being prescribed additional blood pressure medication when the underlying issue may actually be undiagnosed sleep apnea requiring a sleep study?
The racial dimension matters and deserves to be stated plainly. The Caribbean population is predominantly of West African descent, and the science is clear that people of African ancestry carry a disproportionately higher burden of OSA and its cardiovascular consequences. The research base exists largely in the United States, but the biology does not stop at the coastline. Early Caribbean research points in the same direction: a study conducted in Haiti, one of the first of its kind in the region, found that nearly three-quarters of participants reported excessive daytime sleepiness, a hallmark symptom of OSA. These findings underscore the need for more research to determine how prevalent these disorders are across our region.
Obstructive sleep apnea has long been overlooked, despite being a treatable condition and a likely contributor to many of the chronic illnesses plaguing our communities. Sleep, more broadly, is not something that can be sacrificed; it is essential for the body’s repair and restoration. A growing body of research links OSA to hypertension, diabetes, and heart disease, making awareness among both physicians and patients urgently necessary. Given the scale of Grenada’s chronic disease crisis, one of the most important first steps toward healing may be something as simple and as powerful as a better night’s sleep.
Dr Kamilah Spencer is a board-certified Sleep Medicine and Internal Medicine physician building a virtual medical practice in the Caribbean.
Comment:
Dr. Kamilah Spencer’s article is both timely and highly valuable. In a nation where hypertension and diabetes have reached alarming levels, highlighting the often-overlooked role of Obstructive Sleep Apnea (OSA) is a much-needed contribution to public health discourse in Grenada and the wider Caribbean.
The connection Dr. Spencer draws between OSA, and resistant hypertension is particularly important. However, it is essential to recognize that obesity stands as the primary driver behind the rising prevalence of OSA in our population. The persistent preference for fast foods and calorie-dense, ultra-processed meals over nutrient-rich traditional alternatives has significantly contributed to this crisis. Our dietary tastes have shifted dramatically with the heavy marketing and consumption of meat, dairy products, refined oils (including olive oil), and other energy-dense foods promoted as “healthy” options.
In truth, the root causes of OSA, and some forms of Central Sleep Apnea (via strokes) are closely intertwined with the same factors driving the explosion of obesity, hypertension, atherosclerosis, strokes, heart attacks, certain cancers, erectile dysfunction, arthritis, and osteoporosis. These are largely diseases of affluence, fueled by chronic calorie excess and poor dietary quality in part, rather than the diseases of poverty our grandparents faced. Diseases of Poverty (also called diseases of the poor) are illnesses that predominantly affect people living in poverty due to poor sanitation, malnutrition, lack of clean water, limited healthcare access, and overcrowded living conditions.
Brief Examples:
Infectious/Communicable Diseases:
Malaria
Tuberculosis (TB)
HIV/AIDS (especially in low-resource settings)
Diarrheal diseases (e.g., cholera, dysentery)
Respiratory infections (pneumonia)
Neglected Tropical Diseases (e.g., schistosomiasis, hookworm, trachoma)
Nutritional Deficiency Diseases:
Severe malnutrition (Marasmus, Kwashiorkor)
Vitamin deficiencies (e.g., Vitamin A blindness, Rickets, Beriberi)
Other Common Ones:
Maternal and child mortality conditions
Parasitic infections
These diseases are largely preventable and treatable with basic public health measures (clean water, vaccines, nutrition, sanitation). They contrast with diseases of affluence (heart disease, type 2 diabetes, obesity, hypertension, certain cancers), which are more common in wealthier populations due to over-nutrition, sedentary lifestyles, and processed foods.
Modern food environments appear intentionally engineered to promote over-consumption and metabolic dysfunction.
While Dr. Spencer is correct in urging greater awareness and clinical attention to sleep disorders, the challenge before us is much broader. We must examine not only the downstream effects (using a telescope) but also the deeper, systemic dietary and lifestyle drivers (using a microscope) that are fueling this interconnected web of chronic disease.
Thank you, Dr. Spencer, for bringing this important issue to light. Greater public education on sleep health, combined with a national recommitment to balanced, whole-food nutrition, will be critical if we are to reverse the tide of non-communicable diseases in Grenada.
With our limited medical resources, few specialists, and constrained access to modern equipment, the toll of these diseases of affluence is already being felt acutely. Compounding this challenge is the lack of widespread, structured training for our physicians in the latest best practices for managing these complex, interconnected conditions. As a result, we are losing far too many members of our younger population prematurely to preventable conditions such as hypertension, OSA, diabetes, stroke, and heart disease. If we fail to address this growing crisis now, through better physician training, public education, and lifestyle interventions, we place the entire population at serious risk of premature death and long-term disability. Thank You.