The role of sleep disturbances in the association between housing conditions and subjective cognitive impairment

Abstract

AbstractBackgroundAdverse housing conditions such as crowding, air pollution, or insufficient heat are associated with cognitive impairment. However, the mechanism linking adverse housing conditions and cognitive impairment is not fully understood. Adverse housing can affect sleep – an essential physiologic activity for cognitive function, yet this pathway is understudied. We tested associations between housing condition, sleep disturbances, and cognitive impairment.MethodsThis study utilized data from the Health and Retirement Study, a longitudinal panel study among adults (2020). Participants (n = 2,639) completed questionnaires on housing, sleep disturbances, and cognition. Housing was measured by self‐reported ratings of their homes physical condition (1‐excellent to 5‐poor). Sleep disturbances were self‐reported as trouble falling asleep, trouble waking up during the night, and trouble with waking up too early and not being able fall asleep again, and each item was scored from 0 (rarely/never) to 2 (most of the time). Cognitive impairment was defined as a participant rating of fair or poor regarding their memory at the present time. Logistic regression models were fit to test associations between housing and sleep and cognitive impairment after adjustment for age, sex, and race.ResultsThe sample had a mean age of 66.2+10.6 years, and 60% were female, 21.4% Black, 64.6% White, and 11.4% other racial group. The prevalence of cognitive impairment and sleep disturbance was 28.7% and 42.8%, respectively. Individuals living in adverse housing conditions had 32% and 48% higher odds of sleep disturbances [Adjusted Odds Ratio (aOR) = 1.32, 95% confidence interval (1.21, 1.43)] and cognitive impairment [aOR = 1.48 (1.36, 1.62)], respectively. Sleep disturbances were associated with higher odds of cognitive impairment, OR = 2.04 (1.71, 2.44). After adjustment for sleep disturbances, the association between housing condition and cognitive impairment was slightly attenuated, aOR = 1.40 (1.28, 1.54).ConclusionsLiving in adverse housing conditions were associated with greater sleep disturbances and subjective cognitive impairment. Results suggest that sleep may explain a small portion of the association between housing conditions and cognitive impairment, but a formal test of mediation is needed. Housing and sleep may be points of intervention for reducing cognitive impairment.