Addressing Sleep as a Road to Reduce Health Disparities: A Call for Action

Diana A. Chirinos, PhD; Sarah Burkart, PhD; Julia Russell, MA & Jessica R. Dietch, PhD; Sleep SIG

Insufficient sleep is an important public health problem, with a report by the US Institute of Medicine estimating that approximately 50-70 million Americans are affected by sleep complaints¹. Individuals from racial/ethnic minority backgrounds (e.g., Black, Hispanic/Latino, Native American, Asians/Pacific Islander) appear to be disproportionately affected. In fact, a recent scoping review on the topic concluded that Black, Hispanic/Latino, and Asian adults report significantly shorter sleep duration when compared to Non-Hispanic White adults². Similarly, lower sleep efficiency and unfavorable sleep stages were observed among Black compared to Non-Hispanic White adults. Other studies have reported differences in objectively measured sleep duration³, sleep quality³, sleep disordered breathing⁴, and other less prevalent sleep disorders⁵.

Despite advances in our scientific knowledge of sleep and the development of highly effective treatments for sleep disorders, disparities in sleep continue to be reported⁶. In the case of sleep duration, a recent study that examined trends across 14 years (2004-2018) found a significant increase in both short (< 6 hours) and long sleep duration (> 9 hours) among Black and Hispanic adults⁷, as an example. In 2018, compared with Non-Hispanic Whites, the prevalence of short sleep was higher by 11 percentage points among Black and Hispanic adults. The difference in long sleep duration was 2 percentage points higher in Black adults, only. Interestingly, disparities were greater among women and among those with middle or high household income, suggesting that while high income may prevent Non-Hispanic White adults from experiencing insufficient sleep, this protective effect is not observed among individuals of racial/ethnic minority backgrounds.

Unfortunately, the persistency and widening of sleep disparities among adults may contribute to overall health disparities. Previous research shows that insufficient sleep duration alone puts individuals at increased risk of depression, reduced quality of life, cardiovascular disease, diabetes, and death, among other conditions⁷. Long sleep duration, while less well understood, appears to also increase risk for adverse health outcomes⁸. Fortunately, sleep is a modifiable behavior that has and continues to be a challenging endeavor for behavioral scientists and other healthcare providers in the field of behavioral medicine. Therefore, we play an active role in ameliorating and potentially reversing these trends. In 2020, the National Institute on Minority Health and Health Disparities, the National Heart, Lung, and Blood Institute, and the Office of Behavioral and Social Sciences Research published a report on the causes and consequences of sleep health disparities. This report outlined strategies that can serve as a roadmap for research efforts⁹. The research strategies were organized into four different priorities:

1. Developing and promoting integrative research on sleep health disparities: this includes efforts to develop an integrative and testable conceptual framework for studying sleep health disparities as well as promoting integrative research approaches.
2. Investigating the causes and consequences of sleep disparities: this includes the role of sociocultural and physical build environmental determinants of sleep disparities as well as investigating their health and social consequences.
3. Developing interventions to address sleep health disparities: this focuses on multilevel, culturally tailored interventions as well as the study of mediators and modifiers for health outcomes.
4. Building the research infrastructure and training opportunities for the study of sleep health disparities: this key priority includes optimizing the use of existing data to promote advancement of methodologies and research infrastructure as well as promoting a training pipeline that develops a diverse workforce capable of conducting transdisciplinary research on health disparities.

As the Sleep SIG leadership team, we encourage our members and the members of the society at large to put our skills to work so our field can continue to flourish and contribute to our goal of promoting health equity and reducing disparities in sleep and overall health.

References:

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2. Ahn S, Lobo JM, Logan JG, et al.: A scoping review of racial/ethnic disparities in sleep. Sleep Medicine. 2021, 81:169-179.
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5. Chen X, Wang R, Zee P, et al.: Racial/Ethnic Differences in Sleep Disturbances: The Multi-Ethnic Study of Atherosclerosis (MESA). Sleep. 2015, 38:877-888.
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