0874 Population-Level Predictors of Habitual Snoring in a U.S. National Pediatric Cohort: Insights from the ABCD Study

Abstract Introduction The prevalence of pediatric Habitual snoring (HS, ≥3 nights/week) is highly prevalent among children in the U.S. Although adenotonsillar hypertrophy and elevated body mass index (BMI) are known risk factors for childhood sleep-disordered breathing (SDB), less is known on the contribution of modifiable sociodemographic and environmental factors in community-based populations. We hypothesize that sociodemographic and neighborhood characteristics are independently associated with HS in a large community-based pediatric cohort. Methods Cross-sectional analysis of the Adolescent Brain Cognitive Development (ABCD) cohort study of children aged 9-10 at baseline and on yearly evaluations 1-4. Predictors included sex, race/ethnicity, obesity (BMI percentile 95), environmental tobacco smoke exposure (ETS), and census-tract Childhood Opportunity Index (COI 2.0). HS derived from the Sleep Disturbance Scale for Children and compared to “no snoring” (snoring 0 nights/week). Statistical analyses utilized t-tests, chi-square tests, and stepwise logistic regression models, adjusting for relevant SDB covariates. Results At baseline, among 11,868 children (mean age 9.96±0.62 years), 59% reported no snoring, 34.2% non-habitual snoring, and 6.8% HS. HS prevalence differed by race/ethnicity: 14.3% in NH-Black/AA, 7.9% in NH-Asian, 7.4% in Hispanics and 7.3% in NH-Other, compared to 4.3% NH-Whites (p< 0.01). Compared to children with no snoring, HS children were more likely to reside in low-to-very-low COI opportunity neighborhoods (43.9% vs. 25.8%, p< 0.01), had higher rates of obesity (33.2% vs 12.4%, p< 0.01) and ETS exposure (33.6% vs 19.2%, p< 0.01). In multivariable logistic regression models fitted separately for baseline through year 4 (adjusting for baseline sex, obesity, and ETS), low-to-very-low COI consistently predicted higher odds of HS across all time points (OR range 1.57–1.96), in addition to obesity (OR range: 2.68–3.02) and ETS (OR range 1.40–2.00). In models additionally adjusted for race/ethnicity compared to NH-Whites, minority groups demonstrated elevated odds across the majority of time points: NH-Black/AA (OR range 1.84–2.93), NH-Asian (OR range 1.12–3.09), Hispanic (OR range 1.13–1.74), and NH-Other (OR range 1.40–1.73). Conclusion Neighborhood-level characteristics and minority race/ethnicity were independently associated with HS in children. These findings underscore the importance of investigating population-level determinants of pediatric SDB to inform targeted prevention and equitable management. Support (if any) Robert A. Winn Excellence in Clinical Trials Award