Cited by 67Obstructive Sleep Apnea ResearchUrban Transport and AccessibilitySleep and related disorders

Neighborhood Walking Environment and Activity Level Are Associated With OSA

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Billings, Martha E., Johnson, Dayna A., Simonelli, Guido, Moore, Kari, Patel, Sanjay R., Diez Roux, Ana V., Redline, Susan·2016·Chest

Abstract

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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Crossref · 10.1016/j.chest.2016.06.012

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  • Residing in less favorable walking environments has been associated with more severe sleep apnea, especially in male and obese individuals.

    “Residing in less favorable walking environments has been associated with more severe sleep apnea especially in male and obese individuals.124”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [124]

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Authors
Billings, M. E., Johnson, D. A., Simonelli, G., Moore, K., Patel, S. R., Diez Roux, A. V., & Redline, S.
Affiliations
  • University of Washington (US)
  • Brigham and Women's Hospital (US)
  • Walter Reed Army Institute of Research (US)
  • Drexel University (US)
  • University of Pittsburgh (US)
Corresponding author
Billings, Martha E.
Venue
Chest
Publisher
Elsevier BV
Published
2016-11
Volume
150
Issue
5
Pages
1042-1049
ISSN
0012-3692 (ISSN-L)
OpenAlex
W2420665691
Cited by
67
References
59
Citations by year
2026: 3 · 2025: 10 · 2024: 6 · 2023: 9 · 2022: 8 · 2021: 7 · 2020: 4 · 2019: 7 · 2018: 6 · 2017: 4 · 2016: 3
FWCI
5.36
Type
journal article
Language
en
Open access
Locations
  • CHEST Journal (acceptedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Heart, Lung and Blood Institute (NHLBI) at the National Institutes of Health (N01-HC-95159, N01-HC-95169)
  • National Center for Research Resources (UL1-TR-000040, UL1-TR-001079)
  • NHLBI (R01 HL071759, R01 L098433)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Transportation › Urban Transport and Accessibility
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
obstructive sleep apnea, walkability, physical activity, apnea-hypopnea index, obesity, sex differences, body mass index, neighborhood effects, cardiovascular risk, Multi-Ethnic Study of Atherosclerosis
MeSH terms
Aged, Aged, 80 and over, Female, Humans, Longitudinal Studies, Male, Middle Aged, Residence Characteristics, Risk Factors, Severity of Illness Index, Walking, Polysomnography, Risk Assessment, Sleep Apnea, Obstructive, Atherosclerosis

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