Associations among Neighborhood, Race, and Sleep Apnea Severity in Children. A Six-City Analysis

Wang, Rui; Dong, Yan; Weng, Jia; Kontos, Emily Z.; Chervin, Ronald D.; Rosen, Carol L.; Marcus, Carole L.; Redline, Susan

doi:10.1513/annalsats.201609-662oc

Cited by 75 publications

(48 citation statements)

References 50 publications

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“…More recently, builtenvironment and neighborhood-walkability features have been associated with sleep apnea (37). Neighborhood disadvantage, as quantified by census-track indicators of poverty, low education attainment, and family structure, has been associated with an increased risk of sleep apnea in children (38)(39)(40), but not yet in adults. These pediatric studies postulated that geographic differences in sleep disorders may relate to air quality, but did not have data to address this hypothesis.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

The Association of Ambient Air Pollution with Sleep Apnea: The Multi-Ethnic Study of Atherosclerosis

et al. 2018

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Rationale: Air pollution may influence sleep through airway inflammation or autonomic nervous system pathway alterations. Epidemiological studies may provide evidence of relationships between chronic air pollution exposure and sleep apnea.Objectives: To determine whether ambient-derived pollution exposure is associated with obstructive sleep apnea and objective sleep disruption.Methods: We analyzed data from a sample of participants in MESA (Multi-Ethnic Study of Atherosclerosis) who participated in both the Sleep and Air studies. Mean annual and 5-year exposure levels to nitrogen dioxide (NO 2 ) and particulate matter < 2.5 mm in aerodynamic diameter (PM 2.5 ) were estimated at participants' homes using spatiotemporal models based on cohortspecific monitoring. Participants completed in-home full polysomnography and 7 days of wrist actigraphy. We used multivariate models, adjusted for demographics, comorbidities, socioeconomic factors, and site, to assess whether air pollution was associated with sleep apnea (apnea-hypopnea index > 15) and actigraphy-measured sleep efficiency. Results:The participants (n = 1,974) were an average age of 68 (69) years, 46% male, 36% white, 24% Hispanic, 28% black, and 12% Asian; 48% had sleep apnea and 25% had a sleep efficiency of <88%. A 10 ppb annual increase in NO 2 exposure was associated with 39% greater adjusted odds of sleep apnea (95% confidence interval [CI], 1.03-1.87). A 5 mg/m 3 greater annual PM 2.5 exposure was also associated with 60% greater odds of sleep apnea (95% CI, 0.98-2.62). Sleep efficiency was not associated with air pollution levels in fully adjusted models.Conclusions: Individuals with higher annual NO 2 and PM 2.5 exposure levels had a greater odds of sleep apnea. These data suggest that in addition to individual risk factors, environmental factors also contribute to the variation of sleep disorders across groups, possibly contributing to health disparities.

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Section: Sensitivity Analysesmentioning

confidence: 99%

The Association of Ambient Air Pollution with Sleep Apnea: The Multi-Ethnic Study of Atherosclerosis

et al. 2018

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“…Thus far, limited data indicate that the risk of adverse health outcomes such as daytime sleepiness and cardiometabolic outcomes may also be higher in these populations. It is important to note that socioeconomic status (SES), neighborhood disadvantage, and poverty have been shown to mediate the elevated risk of OSA in AAs, underscoring the importance of considering and controlling for psychosocial factors in future studies of racial inequalities 54–56 .…”

Section: Inequalities In Obstructive Sleep Apneamentioning

confidence: 99%

Genetic Ancestry for Sleep Research

Prasad

Saxena

Goel

et al. 2018

Chest

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Recent evidence has highlighted the health inequalities in sleep behaviors and sleep disorders that adversely affect outcomes in select populations, including African-American and Hispanic-American subjects. Race-related sleep health inequalities are ascribed to differences in multilevel and interlinked health determinants, such as sociodemographic factors, health behaviors, and biology. African-American and Hispanic-American subjects are admixed populations whose genetic inheritance combines two or more ancestral populations originating from different continents. Racial inequalities in admixed populations can be parsed into relevant groups of mediating factors (environmental vs genetic) with the use of measures of genetic ancestry, including the proportion of an individual's genetic makeup that comes from each of the major ancestral continental populations. This review describes sleep health inequalities in African-American and Hispanic-American subjects and considers the potential utility of ancestry studies to exploit these differences to gain insight into the genetic underpinnings of these phenotypes. The inclusion of genetic approaches in future studies of admixed populations will allow greater understanding of the potential biological basis of race-related sleep health inequalities.

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“…It must be noted that obesity, associated with OSA and CVD, is also disproportionately high in black population, as 63% of men and 77% of women in this ethnic group is either overweight or obese [11]. Per the Multi-ethnic study of atherosclerosis (MESA), black population demonstrated the highest levels of sleep disturbance, shorter sleep duration, worse sleep quality and daytime sleepiness compared to Caucasians, Hispanics and Asians [12]. Higher poverty rate is also associated with higher apnea-hypopnea index (AHI) with relatively lower continuous positive airway pressure (CPAP) therapy acceptance rate [13,14].…”

Section: Introductionmentioning

confidence: 99%

“…There are many proposed hypotheses as to why these discrepancies may exist, including poor access to health care services, non-adherence to treatment recommendations, inadequate training and environmental and genetic variations [12,15]. Although the existence of association in these conditions are widely acknowledged, the understanding of the roles in how these diseases influence each other is not well investigated.…”

Section: Introductionmentioning

confidence: 99%

Obesity, Cardiovascular Disease and Sleep Disorders: Insights into the Rising Epidemic

Sharma¹,

Lee²,

Youssef³

et al. 2017

J Sleep Disord Ther

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Cardiovascular disease (CVD) is the main cause of death among adult men and women in the USA and impacts millions around the globe. Traditional risk factors for CVD include obesity, diabetes, hypertension and dyslipidemia. The modern-day epidemic of obesity not only increased the rate of CVD but also ushered in an additional CVD risk factor to be added to the list; that is obstructive sleep apnea (OSA). In this review, we discuss the growing epidemic of obesity and OSA, highlighting the common pathogenic hypotheses linking these risk factors to CVD. We will also highlight the therapeutic rationale of OSA as a way to reduce CVD risk.

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Associations among Neighborhood, Race, and Sleep Apnea Severity in Children. A Six-City Analysis

Cited by 75 publications

References 50 publications

The Association of Ambient Air Pollution with Sleep Apnea: The Multi-Ethnic Study of Atherosclerosis

The Association of Ambient Air Pollution with Sleep Apnea: The Multi-Ethnic Study of Atherosclerosis

Genetic Ancestry for Sleep Research

Obesity, Cardiovascular Disease and Sleep Disorders: Insights into the Rising Epidemic

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