Rationale: Neighborhood disadvantage (ND) has been associated with sleep-disordered breathing (SDB) in children. However, the association between ND and SDB symptom burden and quality of life (QOL) has not yet been studied.

Objectives: To evaluate associations between ND with SDB symptom burden and QOL.

Methods: Cross-sectional analyses were performed on 453 children, ages 3–12.9 years, with mild SDB (habitual snoring and apnea–hypopnea index < 3/h) enrolled in the PATS (Pediatric Adenotonsillectomy Trial for Snoring) multicenter study. The primary exposure, neighborhood disadvantage, was characterized by the Child Opportunity Index (COI) (range, 0–100), in which lower values (specifically COI ⩽ 40) signify less advantageous neighborhoods. The primary outcomes were QOL assessed by the obstructive sleep apnea (OSA)-18 questionnaire (range, 18–126) and SDB symptom burden assessed by the Pediatric Sleep Questionnaire–Sleep-related Breathing Disorder (PSQ-SRBD) scale (range, 0–1). The primary model was adjusted for age, sex, race, ethnicity, maternal education, recruitment site, and season. In addition, we explored the role of body mass index (BMI) percentile, environmental tobacco smoke (ETS), and asthma in these associations.

Results: The sample included 453 children (16% Hispanic, 26% Black or African American, 52% White, and 6% other). COI mean (standard deviation [SD]) was 50.3 (29.4), and 37% (n = 169) of participants lived in disadvantaged neighborhoods. Poor SDB-related QOL (OSA-18 ⩾ 60) and high symptom burden (PSQ-SRBD ⩾ 0.33) were found in 30% (n = 134) and 75% (n = 341) of participants, respectively. In adjusted models, a COI increase by 1 SD (i.e., more advantageous neighborhood) was associated with an improvement in OSA-18 score by 2.5 points (95% confidence interval [CI], −4.34 to −0.62) and in PSQ-SRBD score by 0.03 points (95% CI, −0.05 to −0.01). These associations remained significant after adjusting for BMI percentile, ETS, or asthma; however, associations between COI and SDB-related QOL attenuated by 23% and 10% after adjusting for ETS or asthma, respectively.

Conclusions: Neighborhood disadvantage was associated with poorer SDB-related QOL and greater SDB symptoms. Associations were partially attenuated after considering the effects of ETS or asthma. The findings support efforts to reduce ETS and neighborhood-level asthma-related risk factors and identify other neighborhood-level factors that contribute to SDB symptom burden as strategies to address sleep-health disparities.

Clinical trial registered with www.clinicaltrials.gov (NCT 02562040).

理由：邻里劣势 (ND) 与儿童睡眠呼吸障碍 (SDB) 相关。然而，ND 和 SDB 症状负担与生活质量 (QOL) 之间的关联尚未得到研究。

目的：评估 ND 与 SDB 症状负担和生活质量之间的关联。

方法：对参加 PATS（小儿打鼾腺样体扁桃体切除术试验）多中心研究的 453 名年龄 3-12.9 岁、患有轻度 SDB（习惯性打鼾和呼吸暂停低通气指数 < 3/h）的儿童进行横断面分析。主要暴露，邻里劣势，以儿童机会指数（COI）（范围，0-100）为特征，其中较低的值（特别是 COI ⩽ 40）表示优势较差的邻里。主要结局是通过阻塞性睡眠呼吸暂停 (OSA)-18 问卷（范围，18-126）评估的 QOL，以及通过儿科睡眠问卷-睡眠相关呼吸障碍 (PSQ-SRBD) 量表（范围，0）评估的 SDB 症状负担–1).主要模型根据年龄、性别、种族、民族、母亲教育程度、招募地点和季节进行了调整。此外，我们还探讨了体重指数 (BMI) 百分位数、环境烟草烟雾 (ETS) 和哮喘在这些关联中的作用。

结果：样本包括 453 名儿童（16% 为西班牙裔，26% 为黑人或非裔美国人，52% 为白人，6% 为其他儿童）。 COI 平均值（标准差 [SD]）为 50.3 (29.4)，37% ( n  = 169) 的参与者居住在贫困社区。分别有 30% ( n  = 134) 和 75% ( n  = 341) 的参与者与 SDB 相关的生活质量较差 (OSA-18 ⩾ 60) 和高症状负担 (PSQ-SRBD ⩾ 0.33)。在调整后的模型中，COI 增加 1 SD（即更有利的邻域）与 OSA-18 评分提高 2.5 分（95% 置信区间 [CI]，-4.34 至 -0.62）和 PSQ-SRBD 提高相关得分提高了 0.03 分（95% CI，-0.05 至 -0.01）。在调整 BMI 百分位、ETS 或哮喘后，这些关联仍然显着；然而，在调整 ETS 或哮喘后，COI 和 SDB 相关 QOL 之间的关联分别减弱了 23% 和 10%。

结论：社区劣势与较差的 SDB 相关生活质量和较大的 SDB 症状相关。考虑 ETS 或哮喘的影响后，相关性部分减弱。研究结果支持减少 ETS 和社区层面哮喘相关风险因素的努力，并确定导致 SDB 症状负担的其他社区层面因素，作为解决睡眠健康差异的策略。

临床试验已在 www.clinicaltrials.gov 注册（NCT 02562040）。