We characterized differences in severity, presentation, and treatment compliance in sleep-disordered breathing (SDB) between African Americans (AA) and Caucasians (W). We retrospectively analyzed demographics, proxy measures of socioeconomic position, concurrent illness, presenting complaints, polysomnographic data including respiratory disturbance index (RDI) and time less than 90% O2 saturation (T90), and acceptance of and long-term compliance with CPAP therapy. Over 1 year there were 128 AA, 102 W, and 3 “other.” AA were younger (44.9 ± 14.1 vs. 49.2 ± 14.5 years; P = 0.022), had greater body mass index (BMI) (39.7± 10.7 vs. 33.4 ± 9.2 kg/m2; p < 0.0001), and reported lower estimated median household income (MHI) than W ($33,365 ± 15,236 vs. $52,641 ± 20,209; p < 0.0001). OSA was more severe among AA: (median RDI: AA 32.9, W 29.1 events/h; p = 0.008; median T90: AA 17.6 vs. W 5.3 per minute; P = 0.006). However, after adjustment for BMI and MHI, differences between AA and W in RDI were not significant. Equal frequencies of AA and W accepted and were compliant with CPAP. We conclude that while AA present with more severe OSA than W this was accounted for by factors known to influence OSA severity. Further, there were no racial differences in accepting and adhering to therapy with CPAP.