0132 The role of stress in the association between neighborhood environment and sleep

Abstract

Abstract Introduction Adverse neighborhood characteristics have been associated with poor sleep health. However, the mechanisms through which the neighborhood environment influences sleep are not completely understood. We examined the role of perceived stress in the association between neighborhood environment and sleep. Methods Between 2010 and 2013, 2,001 Multi-Ethnic Study of Atherosclerosis (MESA) participants completed the Neighborhood and Sleep Ancillary studies. Neighborhood aesthetic quality and neighborhood social environment were measured among MESA participants and an independent sample of individuals living in the same neighborhood (defined as census tracts) using survey-based methods and geographic information systems at the census tract level. Responses from MESA participants and neighborhood informants were aggregated at the neighborhood level using empirical Bayes estimation to improve reliability and precision. MESA participants completed 1-week wrist actigraphy, yielding measures of average sleep duration and sleep efficiency. Stress was measured using the 4-item Perceived Stress Scale. Multi-level linear regression models were fit to examine associations between neighborhood aesthetic quality or social environment, perceived stress, and sleep duration or efficiency. Results The average age of the study population was 68.5 years (standard deviation [SD]=9.10), and 54% were women. The average sleep duration and sleep efficiency were 388.9 minutes (SD=80.8) and 89.8% (SD=3.7), respectively. A SD increase in neighborhood aesthetic quality or social environment was associated with 6.02 (95% CI 1.89, 10.14) and 6.96 (95% CI 2.92, 11.00) minutes longer sleep duration, respectively, after adjusting for age, gender, race/ethnicity, study site, and socioeconomic and behavioral factors. Further adjustment for perceived stress attenuated the associations by 2.9-3.6% (neighborhood aesthetic quality: 5.80, 95% CI 1.68, 9.92; neighborhood social environment: 6.76, 95% CI 2.72, 10.80). Neighborhood environment and perceived stress were not associated with sleep efficiency. Conclusion Perceived stress had a modest 2.9-3.6% reduction in the association of neighborhood environment and sleep duration, thus suggesting a partial mediation. Future longitudinal studies with formal mediation analysis are needed to confirm these findings. Support (if any) Support for MESA is provided by the National Heart, Lung, and Blood Institute and contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169, UL1-TR-000040, UL1-TR-001079, UL1-TR-001881, and DK06349. MESA Sleep exam was supported by grant HL098433.