0292 Indoor Sleep Environment and Sleep Health in Low-Income Older Adults: A Convergent Mixed-Methods Study

Abstract Introduction Low-income older adults are disproportionately exposed to suboptimal housing conditions, yet the specific impact of indoor environment on their sleep health remains understudied. This study investigated the relationship between indoor environmental factors and sleep health, while concurrently exploring their lived experiences of sleep environment stressors. Methods We conducted a convergent mixed-methods study with data from an ongoing intervention study involving 69 low-income community-dwelling older adults. Objective sleep environment, including air parameters (particulate matter [PM], temperature, humidity, CO₂), sound, and light levels, was assessed for 7 consecutive days using sensors placed in the bedroom. Participants self-reported subjective sleep environment, such as noise, light, temperature, and bedding comfort, using the Assessment of Sleep Environment (ASE). Objective sleep health was measured using wrist actigraphy (ActiGraph): sleep time, efficiency, number of awakenings, and Wake After Sleep Onset (WASO). Subjective sleep health was assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). Correlations and linear regressions were used to understand the associations between nighttime/evening environmental exposures and sleep outcomes. Thirty-two semi-structured interviews were conducted to explore perceived sleep environment stressors. Qualitative data were analyzed using a qualitative descriptive approach with thematic analysis. Results Objective nighttime environmental exposures exceeded recommended sleep thresholds in 28.3%–47.8% of cases. Higher PM exposure during both evening and nighttime was significantly associated with poorer sleep efficiency and increased fragmentation (i.e., awakenings and WASO). Self-reported poor sleep environment (specifically, excessive heat and humidity) was linked to increased PSQI and ISI scores. Five themes regarding sleep environment stressors emerged: 1. Ambient thermal conditions; 2. Mixed perceptions of lighting and safety; 3. Contradictory roles of sound; 4. Intrusive smells (smoking smells); 5. Multidimensional causes of nighttime awakenings. Conclusion Our analysis highlights that objective air pollution (PM) and perceived heat and humidity are associated with poor sleep in low-income older adults. Clinicians should prioritize environmental screening and person-centered strategies—including air filtration and bedroom optimization—to target these modifiable risks and support sleep in low-income older adults. Future studies should employ longitudinal, sensor-based designs to understand cumulative environmental effects on sleep outcomes. Support (if any) This study was supported by National Institute on Aging (1R01AG080613-01A1).