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Duan X, Zhao W, Yang B, Lao L, Mei Y, Wu C, Liao Y, Wang Y, Feng Z, Chen W, Ge E, Deng H, Liu X. Association of residential greenness with obstructive sleep apnea among Chinese old adults and the mediation role of PM 2.5 and leisure-time physical activity. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 915:170120. [PMID: 38232829 DOI: 10.1016/j.scitotenv.2024.170120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
Few studies have investigated the association of residential greenness with obstructive sleep apnea (OSA). This study was to comprehensively examine the association of residential greenness exposure with OSA and explore the mediating effect of leisure-time physical activity (LTPA) and PM2.5 on the association among Chinese old adults. A prospective cohort study that enrolled 2027 adults aged ≥65 was conducted between 1st July 2015 and 30th September 2019 in Southern China. OSA was ascertained by Berlin Questionnaire. Greenness exposure was measured by contemporaneous and cumulative average normalized difference vegetation index (NDVI) in the 1000 m radius around each participant's residential address. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated by Cox proportional hazards model to assess the impact of greenness exposure on the incidence of OSA after adjusting for confounders. LTPA and PM2.5 were examined as potential mediators in the aforementioned models. A total of 293, nearly 14.5 %, participants developed OSA within 59,251 person-months of follow-up. When comparing the highest with lowest tertiles, both contemporaneous NDVI (>0.351 vs. ≤0.325: HR = 0.20, 95 % CI = 0.13-0.31) and cumulative NDVI (> 0.346 vs. ≤ 0.317: HR = 0.32, 95 % CI = 0.21-0.47) were associated with a reduced risk of OSA after adjusting for confounders. LTPA and PM2.5 significantly mediated the association between greenness and OSA. In conclusion, this study indicated that exposure to higher residential greenness could decrease OSA risk, and this benefit may be achieved by promoting physical activity and decreasing PM2.5 concentration. The findings suggest to formulate targeted interventional strategies by expanding residential greenness to prevent OSA and reduce disease burden.
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Affiliation(s)
- Xueru Duan
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wenjing Zhao
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Boyi Yang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lixian Lao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Yunting Mei
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Chuchu Wu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yifu Liao
- Department of Neurology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Yongqi Wang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Zuyi Feng
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Erjia Ge
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Hai Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China.
| | - Xudong Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.
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Kang C, Lee W, Park C, Oh J, Min J, Park J, Choi M, Jang J, Kim H. Beneficial impacts of residential greenness on sleep deprivation in adults aged 19 or older living in South Korea: A nationwide community health survey in 2011-2018. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 914:169700. [PMID: 38160836 DOI: 10.1016/j.scitotenv.2023.169700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/22/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Evidence of the relationship between greenness and sleep is limited, and, given the worsening sleep insufficiency worldwide, this relationship needs elucidation. In this study, we investigated the association of greenness with sleep deprivation using nationwide survey data. METHODS This study included 1,727,273 participants in the Korea Community Health Survey who resided in all 229 districts of South Korea from 2011 to 2018. Sleep deprivation variables were defined as strong deprivation or mild deprivation, based on average daily sleep duration of <5 or 5-6 h, respectively. District-specific annual average of satellite-derived enhanced vegetation index (EVI) was used as a green space exposure. A logistic regression with complex survey weights was used to estimate the association between greenness and sleep deprivation, and it was further examined by sex, age group, educational status, income level, and population density. The regression analysis was performed annually, and the annual estimates were pooled by a combined data analysis. RESULTS A higher level of greenness was associated (odds ratio [95 % confidence interval]) with strong and mild sleep deprivation (0.96 [0.93-0.99] and 0.96 [0.95-0.97]), respectively, and males and the younger age group (<65 years) showed a more prominent association with greenness than in females and the elderly group (65 years or older). In addition, only high-population-density areas showed evident associations of greenness with both strong and mild sleep deprivation. CONCLUSIONS This large population-based study provides important epidemiological evidence for improving sleep quantity through an increase in greenness exposure and supports policymakers in establishing strategies for urban planning.
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Affiliation(s)
- Cinoo Kang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Whanhee Lee
- School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 50612, Republic of Korea.
| | - Chaerin Park
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Jieun Oh
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Jieun Min
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, 25 Magokdong-ro 2-gil, Ganseo-gu, Seoul 07804, Republic of Korea.
| | - Jinah Park
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Munjeong Choi
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Jeongju Jang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
| | - Ho Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
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Chen Y, Hu Y, Li R, Kang W, Zhao A, Lu R, Yin Y, Tong S, Yuan J, Li S. Association of residential greenness with chronotype among children. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 903:166011. [PMID: 37541519 DOI: 10.1016/j.scitotenv.2023.166011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/18/2023] [Accepted: 08/01/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The association between residential greenness and chronotype remains unclear, especially among children. The current study aimed to explore the associations between residential greenness and chronotype parameters in children and examine potential pathways for these associations. METHODS In this cross-sectional study, 16,421 children ages 3-12 were included. Two satellite-derived vegetation indices, i.e., the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI), were used to estimate residential greenness. The mid-sleep point on a workday (MSW) and the mid-sleep point on free days (MSF) were considered. And mid-sleep time on free days adjusted for sleep debt (MSFsc) was used as an indicator of chronotype. In addition to multivariable linear regression models, subgroup analyses were conducted to explore effect modifiers, and mediation analyses were used to explore possible mediating mechanisms of air pollutants underlying the associations. RESULTS An interquartile range (IQR) increase in both NDVI500-m and EVI500-m was significantly associated with an earlier MSFsc of -0.061 (95 % confidence interval (CI): -0.072, -0.049) and -0.054 (95 % CI: -0.066, -0.042), respectively. Non-linear dose response relationships were discovered between greenness indices and MSFsc and MSF. The results of stratified analyses showed the effect of residential greenness on MSW was stronger among primary school children and individuals with higher household income than among kindergarten children and those with lower household income. The joint mediation effects of PM2.5, PM1, PM10, NO2, and SO2 on the associations of NDVI500-m and EVI500-m with MSFsc were 89.6 % and 76.0 %, respectively. CONCLUSIONS Higher levels of residential greenness may have beneficial effects on an earlier chronotype in the child population, by reducing the effects of air pollutants, especially PM2.5. Our research hopes to promote the deployment of green infrastructure and healthy urban design strategies.
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Affiliation(s)
- Yiting Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yabin Hu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenhui Kang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anda Zhao
- Department of Nutrition, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruoyu Lu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shilu Tong
- National Institute of Environmental Health, Chinese Centers for Disease Control and Prevention, Beijing, China; School of Public Health, Anhui Medical University, Hefei, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Jiajun Yuan
- Child Health Advocacy Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shenghui Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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