Neighborhood Walking Environment and Activity Level Are Associated With OSA: The Multi-Ethnic Study of Atherosclerosis.
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.
UW Medicine Sleep Center, Division of Pulmonary Critical Care, University of Washington, Seattle, WA. Electronic address: mebillin@uw.edu.
Martha E
ME
Billings
Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Dayna A
DA
Johnson
Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD.
Guido
G
Simonelli
Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
Kari
K
Moore
Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
Sanjay R
SR
Patel
Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
Ana V
AV
Diez Roux
Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Susan
S
Redline
D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000208:ethnology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000208:ethnology*; D016138:Walking
OSA; activity; neighborhood