Evidence map›Paper›PMID 42119537›Full record

ArticleSleep medicine2026

Environmental, social, and health burdens in relation to sleep-disordered breathing among patients of community-based health center clinics in the United States.

Wensu Zhou, Symielle A Gaston, Ian D Buller, Rupsha Singh, Kathryn S Konrad, Dayna T Neo, W Braxton Jackson, Robert Voss, Paul D Juarez, Chandra L Jackson

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Sleep medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Wensu ZhouEpidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA.
Symielle A GastonEpidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA.
Ian D BullerDLH, LLC, Bethesda, MD, USA.
Rupsha SinghEpidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA.
Kathryn S KonradDLH, LLC, Bethesda, MD, USA.
Dayna T NeoDLH, LLC, Bethesda, MD, USA.
W Braxton JacksonDLH, LLC, Bethesda, MD, USA.
Robert VossOCHIN, Portland, OR, USA.
Paul D JuarezWilberforce University, Wilberforce, OH, USA.
Chandra L JacksonEpidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA; Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA. Electronic address: Chandra.Jackson@nih.gov.

Funding

Environmental and Social Determinants of Health GroupZIAES103325 · NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES · 2025 to 2025
$2.0M
Intramural NIH HHS ZIA ES103325
6 · The paper itself

Abstract

STUDY

objectivesWe investigated associations between community-level environmental, social, and health burdens in relation to sleep-disordered breathing (SDB) prevalence and evaluated effect modification by age, sex, race, and ethnicity.

methodsWe conducted a cross-sectional study using electronic health records from 1,406,727 patients (median age: 44.0 years; 40.3% men) at U.S. community health centers in 2022. Patients' residential addresses in 2022 were linked to a census tract-level environmental, social, and health burden (ESHB) index, reflecting community socioeconomic, environmental, and health burden (percentile rank range: 0-1; higher values indicate greater burden). SDB was identified via diagnostic and procedural codes and categorized as obstructive (OSA), central (CSA), other/unspecified (OUSA), multiple sleep apneas, or procedure-based cases. Log-binomial regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs), with effect modification assessed using interaction terms.

resultsSDB prevalence was 6.0% (OSA: 4.1%; CSA: 0.03%; OUSA: 1.5%; multiple apneas: 0.04%; procedure-based: 0.2%). Each 0.1-unit increase in ESHB percentile rank was associated with higher prevalence of SDB (aPR = 1.01 [1.01-1.01]), OUSA (aPR = 1.01 [1.01-1.02]), and procedure-based cases (aPR = 1.04 [1.02-1.05]) but not CSA, OSA, or multiple sleep apneas. Stronger ESHB-OSA associations were observed among younger (18-49 vs. ≥50 years), American Indian/Alaska Native and White (vs. Asian and multiracial groups), and non-Hispanic (vs. Hispanic) patients.

conclusionHigher overall census tract-level environmental, social, and health burden, as measured by the ESHB index, was associated with higher SDB prevalence with variation by sociodemographic group. Although prospective studies are warranted, our findings illuminate the potential for community-level factors to inform SDB interventions.

Indexed as

Community Health CentersSleep Apnea SyndromesAdolescentAdultAgedCross-Sectional StudiesFemaleHumansMaleMiddle AgedPrevalenceSocioeconomic FactorsUnited StatesCommunity-based health center clinicsElectronic health recordsNeighborhood characteristicsOutpatientsSleep apnea syndromesSocial determinants of health

Identifiers

PMID42119537
PMCPMC13267804

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.