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Original Research |

Neighborhood Walking Environment and Activity Level Are Associated with Obstructive Sleep Apnea: The Multi-Ethnic Study of Atherosclerosis

Martha E. Billings, MD, MSc; Dayna Johnson, PhD, MPH, MS; Guido Simonelli, MD; Kari Moore, MS; Sanjay R. Patel, MD, MS; Ana V. Diez Roux, MD, PhD; Susan Redline, MD, MPH
Author and Funding Information

Each author reports no conflict of interest

Funding: NHLBI N01-HC-95159 through N01-HC-95169 MESA parent study; NHLBI R01 HL071759 (Diez Roux) for MESA neighborhood and NHLBI R01 L098433 (Redline) for MESA Sleep

Prior abstract presentation: American Thoracic Society International Meeting, May 2015; Denver CO

1UW Medicine Sleep Center, Division of Pulmonary Critical Care, University of Washington, Seattle, WA

2Department of Medicine, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

3Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD

4Department on Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA

5Department of Medicine, Division of Pulmonary, University of Pittsburgh, Pittsburgh, PA

Corresponding Author: Martha E. Billings, MD, MSc, Assistant Professor of Medicine, Division of Pulmonary Critical Care Medicine, University of Washington, UW Medicine Sleep Center at Harborview, 325 Ninth Avenue, Box 359803, Seattle, WA 98104.


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.06.012
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Abstract

Background  There has been growing interest in understanding how neighborhoods may relate to cardiovascular risk. Neighborhood effects on sleep apnea may be one contributing mechanism. We investigated whether neighborhood walking environment and personal activity levels are related to obstructive sleep apnea.

Methods  We analyzed data from a subpopulation of the Multi-Ethnic Study of Atherosclerosis (MESA), including subjects who participated in both MESA Sleep and Neighborhood studies (n=1,896). Perceived neighborhood walking environment and subjects’ objective activity were evaluated in multivariate, multi-level models for an association with sleep apnea severity as defined by the apnea hypopnea index. Sex, race/ethnicity and obesity were examined as moderators.

Results  Residing in the lowest quartile walking environment neighborhoods (score <3.75) was associated with more severe sleep apnea [mean 2.7 events/hr greater AHI, 95% CI (0.7, 4.6)], after adjusting for demographics, body mass index, co-morbidities, health behaviors, neighborhood socio-economic status and site. Associations were stronger among obese and male individuals. Approximately one standard deviation greater objective activity in men, was associated with a lower AHI [mean -2.4 95% CI (-3.5, -1.3) events/hr]. This association was partially mediated by body mass index (P<0.001).

Conclusions  Living in neighborhoods with a low walking environment score is associated with greater sleep apnea severity, especially in male and obese individuals. In men, greater activity level is associated with less severe sleep apnea, independent of body mass index, co-morbidities and socio-economics. Neighborhood-level interventions that increase walkability and enable increased physical activity may potentially reduce sleep apnea severity.


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