Racial/Ethnic and Social Inequities in Sleep Medicine: The Tip of the Iceberg?

doi:10.1016/j.jnma.2017.04.005

Journal of the National Medical Association

Volume 109, Issue 4, Winter 2017, Pages 279-286

https://doi.org/10.1016/j.jnma.2017.04.005 Get rights and content

Abstract

Purpose

It is known that racial disparities exist in terms of disease prevalence and access to health care. However, the link between race/ethnicity and sleep quality is often under-recognized.

Results

Current evidence shows that differences exist between Blacks and Whites in terms of sleep duration, sleep quality, and the likelihood of acquiring a sleep disorder. It has been argued that the adverse effects of ethnicity on sleep quality or duration interact with other social or personal factors (such as employment) and that the effects of these factors are interactive and need to be analyzed simultaneously. There is a growing body of evidence showing that disturbed sleep is a mediator of the effect of environmental stressors on personal health, which is more pronounced in ethnic minorities.

Conclusions

These findings support the notion that perceived discrimination or unfair treatment has significant associations with complaints of sleep disturbance and disturbed objective measures of sleep quality and sleep architecture. Hence, greater efforts are needed to demonstrate how racial/ethnic factors influence different sleep processes.

Section snippets

Sleep and overall health

An increasing amount of evidence is showing that sleep difficulties are a major health concern. Research carried out by the Institute of Medicine has shown for instance that 50-70 million American adults have disordered or insufficient sleep.¹ While in the opinions of many the significance of inadequate sleep is often diminished, there are nevertheless broader health implications from these findings. Sleep deprivation, as well as sleep disorders which frequently underlie it, have been linked to

Race/ethnicity effects in sleep quality

It is known that racial disparities exist in terms of general health. Compared to whites, Blacks have a greater incidence of various adverse health conditions. These include heart disease, cancer, stroke, diabetes, kidney disease, hypertension, liver cirrhosis and homicide.³⁶ However, the link between race/ethnicity and sleep quality is often under-recognized. Peña et al carried out a longitudinal study of children aged 6 months to 7 years from different racial/ethnic groups and found that,

Racial and ethnic disparities in obstructive sleep apnea

One of the most common sleep disorders is obstructive sleep apnea (OSA), with up to 17% of middle-aged men and 9% of middle-aged women being affected by the condition.⁵⁰ OSA has been linked to a number of secondary effects accruing from the disordered sleep that it causes. Among these are excessive daytime sleepiness, a greater incidence of motor vehicle accidents, hypertension, and cardiovascular diseases.⁵¹

The racial/ethnic disparity in the prevalence of OSA is greatest between Blacks and

Interactive effects between race/ethnicity and personal factors such as occupation and educational attainment; their influence on sleep quality

It has been argued that the adverse effects of ethnicity on sleep quality or duration interact with other social or personal factors (such as employment) and that the effects of these factors are interactive and need to be analyzed simultaneously. In a study of Black and White racial disparities in sleep quality (analyzed by industry and occupation), it was found that an individual's job produces differential effects on sleep duration and that these were mediated by the person's race. The

Effects of racial/ethnic discrimination on sleep

Chronic stress is a significant correlate of sleep disturbance.63, 64 Stress can arise from a number of sources, but one of the more important ones is the quality of social interactions one has on a daily basis. Racial/ethnic discrimination is a chronic stressor, which is experienced by almost all minority groups.⁶⁵ The continuous exposure to discrimination, whether perceived or actual, has a number of interconnected psychological effects. Pearlin et al have proposed a model suggesting that one

Discrimination in the healthcare system

A large number of studies have shown that, compared to Whites, Blacks do not receive equivalent treatment in the U.S. healthcare system, and that this phenomenon is independent of the reduced access to healthcare facilities that Blacks often experience.36, 82 Commenting on the Institute of Medicine Report (2006) upon which this conclusion was based, Smedley et al. (2003) noted that these inequities occurred in a broad range of medical services, including cancer treatment, treatment of

Potential strategies for promoting awareness of the relationship between sleep and health in racial/ethnic minorities

Despite a number of studies highlighting the problem, racial and ethnic inequities in sleep disorder treatment continue to exist. As this review has attempted to illustrate, one of the reasons for lack of progress in addressing these inequities is the continued existence of bias in attitudes toward minority community members, a phenomenon that appears to be widespread across the healthcare system.49, 84 There is evidence that the ability to self-regulate overt or implicit expressions of

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: Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Review ArticleRacial/Ethnic and Social Inequities in Sleep Medicine: The Tip of the Iceberg?

Abstract

Purpose

Results

Conclusions

Section snippets

Sleep and overall health

Race/ethnicity effects in sleep quality

Racial and ethnic disparities in obstructive sleep apnea

Interactive effects between race/ethnicity and personal factors such as occupation and educational attainment; their influence on sleep quality

Effects of racial/ethnic discrimination on sleep

Discrimination in the healthcare system

Potential strategies for promoting awareness of the relationship between sleep and health in racial/ethnic minorities

Soc Sci Med

Prev Med

Am J Med

Biol Psychol

Sleep health

Sleep Med

J Natl Med Assoc

Sleep Med

Behav Res Ther

J Psychiat Res

J Am Coll Cardiol

Lancet

Sleep Med

Biol Psychol

Prev Med

Ann Epidemiol

Sleep Med

Soc Sci Med

Am J Prev Med

Prev Med

Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem

Metabolic, endocrine, and immune consequences of sleep deprivation

Open Respir Med J

Association between perceived interpersonal everyday discrimination and waist circumference over a 9-year period in the midlife development in the United States Cohort Study

Am J Epidemiol

Associations between inadequate sleep and obesity in the US adult population: analysis of the national health interview survey (1977-2009)

Bmc Public Health

Self-reported experiences of discrimination and visceral fat in middle-aged African-American and Caucasian women

Am J Epidemiol

Racial/ethnic differences in sleep disturbances: the Multi-Ethnic Study of Atherosclerosis (MESA)

Sleep

A prospective study of sleep duration and coronary heart disease in women

Arch Intern Med

Habitual sleep patterns and risk for stroke and coronary heart disease: a 10-year follow-up from NHANES I

Neurology

Diurnal rhythms in blood cell populations and the effect of acute sleep deprivation in healthy young men

Sleep

Sustained sleep-deprivation impairs host-defense

Am J Physiol

A prospective study of self-reported sleep duration and incident diabetes in women

Diabetes care

Impact of sleep and sleep loss on neuroendocrine and metabolic function

Horm Res

Insomnia with objective short sleep duration is associated with type 2 diabetes: a population-based study

Diabetes care

Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies

Sleep

Sleep duration and mortality: a systematic review and meta-analysis

J Sleep Res

Mortality associated with sleep duration and insomnia

Arch Gen Psychiat

Mortality in sleep-apnea patients – a multivariate-analysis of risk-factors

Sleep

A prospective study of sleep duration and mortality risk in women

Sleep

Sleep disturbance and risk for alcohol-related problems

Am J Psychiatry

The interplay of sleep disturbance, anxiety, and depression in children

J Pediatr Psychol

Sleep disturbances and mood disorders: an epidemiologic perspective

Depress Anxiety

Sleep problems in childhood: a longitudinal study of developmental change and association with behavioral problems

J Am Acad Child Psy

Sleep and behavior problems among preschoolers

J Dev Behav Pediatr

Sleep and behavior problems in school-aged children

Pediatrics

Review Article
Racial/Ethnic and Social Inequities in Sleep Medicine: The Tip of the Iceberg?