Neighborhood disadvantage linked to poor quality of life in sleep-disordered breathing

Key takeaways:

• Living in a more advantageous neighborhood was linked to better quality of life related to sleep-disordered breathing in children.
• This type of residence was also linked to reduced symptom burden.

Children with sleep-disordered breathing who live in less advantageous neighborhoods may have high symptom burden and poor quality of life, according to results published in Annals of the American Thoracic Society.

“Our findings reveal that greater neighborhood disadvantage across education, health and environment, and social and economic subdomains is associated with poorer sleep-disordered breathing (SDB)-related [quality of life] and increased SDB symptom burden in children with [mild] SDB from multiple centers in the U.S.,” Seyni Gueye-Ndiaye, MD, attending physician in the division of pulmonary medicine at Boston Children’s Hospital and instructor of pediatrics at Harvard Medical School, and colleagues wrote.

In a cross-sectional analysis, Gueye-Ndiaye and colleagues assessed 453 children (mean age, 6.6 years; 52% white; 26% Black/African American; 16% Hispanic) with mild SDB — identified through habitual snoring and an apnea-hypopnea index of less than three events per hour — to determine how SDB symptom burden and quality of life are related to neighborhood disadvantage.

Researchers used the Child Opportunity Index (COI) to find neighborhood disadvantage levels. This index ranges from zero to 100, with a score of 40 or lower indicating less advantageous neighborhoods.

Quality of life related to SDB was determined through OSA-18 questionnaire scores, and researchers deemed a score of 60 or higher, within a scale of 18 to 126, as poor quality of life.

Further, the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder (PSQ-SRBD) scale was used to find symptom burden. This scale ranges from zero to one, with a score of 0.33 or higher indicating high symptom burden.

Assessing the total cohort, researchers observed a mean COI score of 50.3, which signaled moderate advantage. Residence in a disadvantaged neighborhood based on COI was found in 37% of children.

Three-quarters (75%) of the total cohort had high symptom burden, whereas a smaller percentage (30%) had poor condition-related quality of life.

When evaluating neighborhood disadvantage and quality of life, researchers found that an OSA-18 score significantly improved by 2.48 points (95% CI, –4.34 to –0.62) with each 1 standard deviation (SD) rise in COI score following adjustment for age, sex, race, ethnicity, maternal education, recruitment site and season.

This rise in COI by 1 SD also led to significant improvement in symptom burden, with a decrease of 0.028 points (95% CI, –0.05 to –0.01) on the PSQ-SRBD scale found in the same adjusted model.

Further adjustment for BMI percentile, environmental tobacco smoke and asthma did not change the significance of the associations outlined above but did alter the strength of some links, researchers wrote.

Notably, adjustment for environmental tobacco smoke reduced the link between COI and quality of life by 23% (to –1.92 points) and the link between COI and symptom burden by 14% (to –0.024 points).

Researchers also saw a 10% decrease between COI and quality of life (to –2.23 points) when considering asthma, as well as a 10% decrease between COI and symptom burden (to –0.025 points).

“Further research is needed to more clearly define the specific neighborhood environmental risk factors (eg, chemical pollutants, housing factors, green space) that may worsen SDB-related symptoms and clarify the mechanistic pathways underlying these associations,” Gueye-Ndiaye and colleagues wrote.