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Original Research: Sleep Disorders |

Neighborhood Walking Environment and Activity Level Are Associated With OSA: The Multi-Ethnic Study of Atherosclerosis

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

FUNDING/SUPPORT: This research was supported by the National Heart, Lung and Blood Institute (NHLBI) at the National Institutes of Health through contracts N01-HC-95159 through N01-HC-95169 and by grants UL1-TR-000040 and UL1-TR-001079 from the National Center for Research Resources. Additional funding for the ancillary MESA Neighborhood Study was provided by NHLBI grant R01 HL071759 (A. V. D. R.) and for the ancillary MESA Sleep Study from NHLBI grant R01 L098433 (S. R.).

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

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

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

dDepartment of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA

eDepartment of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA

CORRESPONDENCE TO: Martha E. Billings, MD, Division of Pulmonary Critical Care Medicine, University of Washington, UW Medicine Sleep Center at Harborview, 325 Ninth Ave, Box 359803, Seattle, WA 98104


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


Chest. 2016;150(5):1042-1049. doi:10.1016/j.chest.2016.06.012
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Background  There has been growing interest in understanding how neighborhoods may be related to cardiovascular risk. Neighborhood effects on sleep apnea could be one contributing mechanism. We investigated whether neighborhood walking environment and personal activity levels are related to OSA.

Methods  Data were analyzed from a subpopulation of the Multi-Ethnic Study of Atherosclerosis (MESA), including subjects who participated in both the MESA Sleep and Neighborhood studies (N = 1,896). Perceived neighborhood walking environment and subjects’ objective activity were evaluated in multivariate, multilevel models to determine any association with sleep apnea severity as defined by using 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/h greater AHI [95% CI, 0.7 to 4.6]), after adjusting for demographic characteristics, BMI, comorbidities, health behaviors, neighborhood socioeconomic status, and site. Associations were stronger among obese and male individuals. Approximately 1 SD greater objective activity in men was associated with a lower AHI (mean, –2.4 events/h [95% CI, –3.5 to –1.3]). This association was partially mediated by BMI (P < .001).

Conclusions  Living in neighborhoods with a low walking environment score is associated with greater severity of sleep apnea, especially in male and obese individuals. In men, greater activity level is associated with less severe sleep apnea, independent of BMI, comorbidities, and socioeconomic status. Neighborhood-level interventions that increase walkability and enable increased physical activity may potentially reduce the severity of sleep apnea.

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