The Relationship Between Social Vulnerability and Obstructive Sleep Apnea Severity at Referral to a Tertiary Sleep Centre: A Retrospective Observational Study.

RationaleObstructive sleep apnea (OSA) is a common, treatable chronic disease with significant health and societal consequences. Many patients face barriers to care due to systemic inequality, poverty, and other contributors to social vulnerability, leading to delayed diagnosis and more severe disease at presentation. Several studies have examined the impacts of social vulnerability on OSA severity using individual-level factors. However, there is comparatively limited work examining how neighbourhood-level indicators may influence OSA severity. This study aimed to determine whether social vulnerability, measured using a neighbourhood-level multidimensional index, is associated with OSA severity at referral to a tertiary sleep centre. MethodsWe conducted a retrospective observational study of adult patients referred to an academic hospital in Calgary, Canada for evaluation of OSA between November 2016 and November 2019. Patient data were linked using residential postal codes to the Canadian Index of Multiple Deprivation (CIMD), a census-based tool designed to reflect dimensions of social vulnerability in Canadian populations. CIMD divides social vulnerability into four dimensions including residential instability, ethnocultural composition, economic dependency, and situational vulnerability. We employed both linear and logistic mixed-effects models to assess the impact of neighbourhood-level social vulnerability on sleep apnea severity, using postal code as the grouping variable. OSA severity was based on home sleep apnea test (HSAT) derived oxygen desaturation index (ODI). Secondary outcomes included severe OSA (ODI [&ge;] 30), sleepiness based on Epworth Sleepiness Scale (ESS), and severe sleepiness (ESS > 15). ResultsThe study included 2,232 patients, 80% of whom had at least mild OSA. ODI was positively associated with situational vulnerability (p < 0.01) and inversely associated with ethnocultural composition (p < 0.01), though both associations lost significance after adjusting for BMI. ESS was independently associated with situational vulnerability (p < 0.01) and inversely with ethnocultural composition (p = 0.01), independent of BMI and ODI. Severe sleepiness was associated with situational vulnerability (p < 0.01) and residential instability (p = 0.02). ConclusionLiving in a socially deprived area was associated with OSA severity at time of referral, though this relationship appeared to be mediated by BMI. Deprivation dimensions were independently associated with sleepiness, highlighting the broader impact of social-related factors on sleepiness. These findings demonstrate the complex interplay between social vulnerability and sleep disorders and suggest that composite indices like the CIMD can enhance our understanding of these relationships.