Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.
Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland.
J Sleep Res. 2019 Oct;28(5):e12799. doi: 10.1111/jsr.12799. Epub 2018 Nov 25.
Sleep-disordered breathing is a common condition, related to a higher cardiometabolic and neurocognitive risk. The main risk factors for sleep-disordered breathing include obesity, craniofacial characteristics, male sex and age. However, some studies have suggested that adverse socioeconomic circumstances and lifestyle-related behaviours such as smoking and alcohol use, may also be risk factors for sleep-disordered breathing. Here, we investigate the associations between socioeconomic status and sleep-disordered breathing, as measured by sleep apnea-hypopnea and oxygen desaturation indexes. Furthermore, we assess whether these associations are explained by lifestyle-related factors (smoking, sedentary behaviour, alcohol use and body mass index [BMI]). We used data from the CoLaus|HypnoLaus study, a population-based study including 2162 participants from Lausanne (Switzerland). Socioeconomic status was measured through occupation and education. Sleep-disordered breathing was assessed through polysomnography and measured using the apnea-hypopnea index (AHI: number of apnea/hypopnea events/hr: ≥15/≥30 events), and the ≥3% oxygen desaturation index (ODI: number of oxygen desaturation events/hr: ≥15/≥30 events). Lower occupation and education were associated with higher AHI and ODI (occupation: AHI30, odds ratio (OR) = 1.88, 95% confidence interval (CI) [1.07; 3.31]; ODI30, OR = 2.29, 95% CI [1.19; 4.39]; education: AHI30, OR = 1.21, 95% CI [0.85; 1.72]; ODI30, OR = 1.26, 95% CI [0.83; 1.91]). BMI was associated with socioeconomic status and AHI/ODI, and contributed to the socioeconomic gradient in SDB, with mediation estimates ranging between 43% and 78%. In this Swiss population-based study, we found that low socioeconomic status is a risk factor for sleep-disordered breathing, and that these associations are partly explained by BMI. These findings provide a better understanding of the mechanisms underlying social differences in sleep-disordered breathing and may help implement policies for identifying high-risk profiles for this disorder.
睡眠呼吸障碍是一种常见病症，与更高的心脏代谢和神经认知风险相关。睡眠呼吸障碍的主要危险因素包括肥胖、头面部特征、男性性别和年龄。然而，一些研究表明，不利的社会经济环境和与生活方式相关的行为，如吸烟和饮酒，也可能是睡眠呼吸障碍的危险因素。在这里，我们研究了社会经济地位与睡眠呼吸暂停低通气和氧减指数所测量的睡眠呼吸障碍之间的关联。此外，我们评估了这些关联是否可以通过与生活方式相关的因素（吸烟、久坐行为、饮酒和体重指数[BMI]）来解释。我们使用了来自洛桑（瑞士）的 CoLaus|HypnoLaus 研究的数据，这是一项包括 2162 名参与者的基于人群的研究。社会经济地位通过职业和教育来衡量。睡眠呼吸障碍通过多导睡眠图进行评估，并使用呼吸暂停低通气指数（AHI：每小时呼吸暂停/低通气事件数：≥15/≥30 事件）和≥3%的氧减指数（ODI：每小时氧减事件数：≥15/≥30 事件）进行测量。较低的职业和教育水平与更高的 AHI 和 ODI 相关（职业：AHI30，优势比（OR）=1.88，95%置信区间（CI）[1.07；3.31]；ODI30，OR=2.29，95%CI[1.19；4.39]；教育：AHI30，OR=1.21，95%CI[0.85；1.72]；ODI30，OR=1.26，95%CI[0.83；1.91]）。BMI 与社会经济地位和 AHI/ODI 相关，并对 SDB 的社会经济梯度做出贡献，中介估计值在 43%至 78%之间。在这项瑞士基于人群的研究中，我们发现较低的社会经济地位是睡眠呼吸障碍的一个危险因素，这些关联部分可以通过 BMI 来解释。这些发现提供了对睡眠呼吸障碍中社会差异的潜在机制的更好理解，并可能有助于制定针对这种疾病的高危人群的政策。
