Childhood Sleep Apnea and Neighborhood Disadvantage

Abstract

To determine whether neighborhood characteristics or socioeconomic status are risk factors for obstructive sleep apnea (OSA) in young children. In this observational study, we compared residential census tract metrics in Montreal, Canada for 436 children aged 2-8 years who were evaluated for OSA, hypothesizing that the children with proven OSA (OSA group; n = 300) would come from more disadvantaged neighborhoods compared with those children without OSA (no OSA group; n = 136). Children who had undergone previous adenotonsillectomy and those with comorbid disorders were excluded from the analysis. Compared with the no OSA group, the OSA group lived in census tracts with lower median family incomes, higher proportions of children living below the Canadian low-income cutoff (indicating poverty), higher proportions of single-parent families, and greater population densities. The highest probability of having OSA was seen in children referred from the most disadvantaged census tracts and was due primarily to moderate/severe OSA. Group differences remained significant when adjusted for age, race/ethnicity, and obesity. Compared with the children without OSA, those with OSA were more likely to reside in disadvantaged neighborhoods. Future studies should examine whether these results can be replicated in other settings, especially those with large socioeconomic disparities.