title: Influence of neighbourhood-level crowding on sleep-disordered breathing severity: mediation by body size.
abstract: Neighbourhood-level crowding, a measure of the percentage of households with more than one person per room, may impact the severity of sleep-disordered breathing. This study examined the association of neighbourhood-level crowding with apnoea-hypopnoea index in a large clinical sample of diverse adults with sleep-disordered breathing. Sleep-disordered breathing severity was quantified as the apnoea-hypopnoea index calculated from overnight polysomnogram; analyses were restricted to those with apnoea-hypopnoea index ≥5. Neighbourhood-level crowding was defined using 2000 US Census tract data as percentage of households in a census tract with >1 person per room. Multivariable linear mixed models were fit to examine the associations between the percentage of neighbourhood-level crowding and apnoea-hypopnoea index, and a causal mediation analysis was conducted to determine if body mass index acted as a mediator between neighbourhood-level crowding and apnoea-hypopnoea index. Among 1789 patients (43% African American; 68% male; 80% obese), the mean apnoea-hypopnoea index was 29.0 ± 25.3. After adjusting for race, age, marital status and gender, neighbourhood-level crowding was associated with apnoea-hypopnoea index; for every one-unit increase in percentage of neighbourhood-level crowding mean, the apnoea-hypopnoea index increased by 0.40 ± 0.20 (P = 0.04). There was a statistically significant indirect effect of neighbourhood-level crowding through body mass index on the apnoea-hypopnoea index (P < 0.001). Neighbourhood-level crowding is associated with severity of sleep-disordered breathing. Body mass index partially mediated the association between neighbourhood-level crowding and sleep-disordered breathing. Investigating prevalent neighbourhood conditions impacting breathing in urban settings may be promising.
authors.affiliation: Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.|Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.|Department of Public Health Sciences and the Health Disparities Research Collaborative, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Dayna A
authors.initials: DA
authors.lastname: Johnson
authors.affiliation: Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Drake
authors.affiliation: Department of Public Health Sciences and the Health Disparities Research Collaborative, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Christine L M
authors.initials: CL
authors.lastname: Joseph
authors.affiliation: Department of Public Health Sciences and the Health Disparities Research Collaborative, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Krajenta
authors.affiliation: University of Manitoba, 373 Misericordia Health Centre, Winnipeg, MB, Canada.
authors.forename: David W
authors.initials: DW
authors.lastname: Hudgel
authors.affiliation: Department of Public Health Sciences and the Health Disparities Research Collaborative, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Andrea E
authors.identifier: http://orcid.org/0000-0001-8272-4448
authors.initials: AE
authors.lastname: Cassidy-Bushrow
mesh_terms: D015992:Body Mass Index; D049628:Body Size; D019352:Censuses; D003441:Crowding; D005191:Family Characteristics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D017286:Polysomnography; D012119:Respiration; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000503:physiopathology*; D014481:United States; D014505:Urban Population
keywords: apnoa-hypopnoea index; body mass index; mediation analysis, sleep; polysomnography; social determinants of sleep