1226 Social Vulnerability Index as a Predictor of Sleep Quality in Adults with Obstructive Sleep Apnea

Abstract Introduction Social determinants of health (SDoH) are associated with subjective and objective sleep quality in the general population. However, less is known about how SDoH affects sleep quality in obstructive sleep apnea (OSA). We hypothesized that the social vulnerability index (SVI), a comprehensive measure of SDoH and vulnerability based on geocoded data, would be significantly associated with sleep quality in adults with OSA. We examined the association between four SVI subscales and sleep quality. Methods Sixty adults with newly diagnosed OSA were recruited for this single-center study. Participants completed the Pittsburgh Sleep Quality Index (PSQI), questionnaire and underwent overnight polysomnography. Several manually scored and computationally derived EEG-based measures of sleep quality were used as objective indicators of sleep quality. These included manually scored sleep efficiency and arousal index (ArI), as well as the computed cumulative sleep index (CSI) and total arousal and awake index (TArAwI). The Centers for Disease Control SVI was used, which includes four subscales: socioeconomic status (SES), household characteristics (HC), racial & ethnic minority status (REMS), and housing type & transportation (HT). The association of each subscale with sleep parameters was examined. Multivariable linear regression models were adjusted for age, sex, body mass index, and apnea hypopnea index. Results The mean age of participants (N = 60) was 44.9 ± 9.4 years, and most participants were African American or Hispanic males. The mean SVI score was 0.76 ± 0.17, and the mean Apnea Hypopnea Index score was 69.4 ± 40.7. A higher REM subscale was associated with better subjective sleep quality (PSQI, t-statistic = -2.36, p = 0.02), but more objective sleep fragmentation (TArAwI, t-statistic = 2.12, p = 0.03). Higher HT was associated with higher ArI (t-statistic = 2.09, p = 0.04), and higher HC was associated with lower CSI (t-statistic = -2.04, p = 0.04). Conclusion Higher SDoH vulnerability with respect to racial & ethnic minority status, household characteristics, and housing type & transportation is associated with lower objective sleep quality in OSA, independent of age and OSA severity. These factors should be considered when designing and implementing interventions to improve sleep disturbances in OSA. Support (if any) NHLBI R56HL157182