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Introduction Obstructive sleep apnoea (OSA) is a highly prevalent sleep-related breathing disorder with serious health implications, affecting nearly one billion people globally. This review explores ethnic disparities in OSA diagnosis and access to healthcare in the United States (US). OSA is more common in elderly, obese individuals and men, though postmenopausal women are also at increased risk. Ethnic minority groups particularly African American (AA), Native American, Hispanic, and Asian populations experience higher OSA rates. These disparities are driven by systemic racism, unequal resource distribution, cultural beliefs, and language barriers that affect both access and adherence to treatment. This review aimed to assess healthcare access disparities related to OSA in the US.Methods A systematic search was conducted using databases including PubMed, Google Scholar, Scopus, EMBASE, CINAHL, MEDLINE, and the UWE Library. Boolean operators, PICOS criteria, and PRISMA methodology were used to identify relevant literature. ( Figure 1) Study types included retrospective, observational, prospective, randomised controlled, cross-sectional, longitudinal, and case-control designs. (Figure 2)Results From 1204 articles, 86 duplicates were removed. Of the remaining 1118, 1035 were excluded based on title and abstract screening. Eighty-three articles underwent full text review, with 15 meeting all inclusion criteria. These were included in the final analysis.Discussion The findings reveal significant racial disparities in OSA outcomes, posing a public health and economic burden. AAs showed the highest OSA incidence and comorbidity-related mortality. Factors contributing to disparities include socioeconomic status, geographic location, neighbourhood poverty, lack of insurance, cultural beliefs, and mistrust of healthcare systems. Even high-income AAs encounter barriers due to systemic bias, reducing clinic engagement and access to CPAP therapy. Despite advances in healthcare, access remains unequal across ethnic groups, contributing to poorer outcomes. ( Figure 3)Abstract P85 Figure 1Displays the PRISMA Flow diagram, which utilises inclusion and exclusion criteria to depict the systematic data collection process from eight search databasesAbstract P85 Figure 2Illustrates the geographical distribution of patient’s adherent (blue) and nonadherent (red) to their continuous positive airway pressure (CPAP). The data demonstrated 170,641 individuals with valid ZIP codes, accounting for approximately 63.7% of the attainable database (Pandey et al., 2020). The prevalence of nonadherence is more significant in more than half of the areas marked in red in this databaseAbstract P85 Figure 3Shows the sleep apnoea mortality rate by gender and age between blacks and whites in the US from 1999-2019 (Lee, Chang, and Mador, 2022). The mortality rate for black males (green) was found to be higher than that of white males (purple) until the age of >75 years, after which a reverse trend was observed among individuals aged 75-84 years and those aged over >85 years, with a higher mortality rate among white males than black males. Black females (red) have a consistently higher death rate than white females (blue) regardless of the age