Neighborhood Walking Environment and Activity Level Are Associated With OSA The Multi-Ethnic Study of Atherosclerosis
Neighborhood Walking Environment and Activity Level Are Associated With OSA The Multi-Ethnic Study of Atherosclerosis
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DOI：
10.1016/j.chest.2016.06.012
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发表时间：
2016-11-01
期刊：
影响因子：
9.6
通讯作者：
Redline, Susan
中科院分区：
文献类型：
--
作者：
Billings, Martha E.;Johnson, Dayna A.;Redline, Susan
背景：人们对了解社区与心血管风险之间的关系越来越感兴趣。邻居对睡眠呼吸暂停的影响可能是一种促成机制。我们调查了社区步行环境和个人活动水平是否与OSA有关。方法：数据分析来自多民族动脉粥样硬化研究（MESA）的一个亚群，包括参与MESA睡眠和邻里研究的受试者（N - 1896）。感知到的邻里步行环境和受试者的客观活动在多变量、多水平模型中进行评估，以确定与睡眠呼吸暂停严重程度的任何关联，通过使用呼吸暂停-低通气指数来定义。性别、种族/民族和肥胖被认为是调节因素。结果：在调整了人口统计学特征、BMI、合并症、健康行为、社区社会经济地位和地点后，居住在最低四分位数步行环境社区（评分< 3.75）与更严重的睡眠呼吸暂停相关（平均2.7事件/小时，AHI更高[95% CI， 0.7至4.6]）。肥胖和男性个体之间的关联更强。男性客观活动增加约1个标准差与较低的AHI相关（平均-2.4事件/小时[95% CI， -3.5至-1.3]）。BMI在一定程度上介导了这种关联（P < 0.001）。结论：居住在步行环境评分较低的社区与睡眠呼吸暂停的严重程度有关，尤其是在男性和肥胖个体中。在男性中，较高的运动水平与较轻的睡眠呼吸暂停有关，与BMI、合并症和社会经济地位无关。提高步行能力和增加体力活动的社区干预可能会潜在地降低睡眠呼吸暂停的严重程度。
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.