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The Association of Ambient Air Pollution with Sleep Apnea: The Multi-Ethnic Study of Atherosclerosis.

ABSTRACT

Air pollution may influence sleep through airway inflammation or autonomic nervous system pathway alterations. Epidemiological studies may provide evidence of relationships between chronic air pollution exposure and sleep apnea. To determine if ambient-derived pollution exposure was associated with obstructive sleep apnea and objective sleep disruption. We analyzed data from a sample of the Multi-Ethnic Study of Atherosclerosis, including subjects who participated in both the Sleep and Air studies. Mean annual and 5-year exposure levels to ambient air pollutants nitrogen dioxide and PM2.5 were estimated at participants' homes using spatio-temporal models based on cohort-specific monitoring. Participants completed in-home full polysomnography and 7 days of wrist actigraphy. Multivariate models, adjusted for demographics, co-morbidities, socio-economic factors and site, assessed if air pollution was associated with sleep apnea (an apnea hypopnea index ≥15) and actigraphy-measured sleep efficiency Results: Participants (n=1974) were an average age 68 (+/- 9) years, 46% male, 36% white, 24% Hispanic, 28% black and 12% Asian. Of these, 48% had sleep apnea and 25% a sleep efficiency ≤ 88%. A 10 ppb annual increase in nitrogen dioxide exposure was associated with 39% greater adjusted odds of sleep apnea 95% CI (1.03, 1.87). A 5 μg/m3 greater annual PM2.5 exposure was also associated with 60% greater odds of sleep apnea, 95% CI (0.98, 2.62). Sleep efficiency was not associated with air pollution levels in fully adjusted models. Individuals with higher annual NO2 and PM2.5 exposure levels had greater odds of sleep apnea. These data suggest that, in addition to individual risk factors, environmental factors also contribute to the variation of sleep disorders across groups, possibly contributing to health disparities.