Members of Minorities, Low-Income Communities Get Less Sleep, Have More Sleep Problems

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Members of racial and ethnic minorities and socioeconomically disadvantaged populations get less sleep and poorer quality sleep, according to speakers at the virtual joint annual meeting of the American Academy of Sleep Medicine and Sleep Research Society in August.

Members of minorities and lower income populations also have higher rates of sleep disorders including obstructive sleep apnea (OSA) than non-Hispanic White individuals, speakers said.

Good quality sleep promotes overall wellness, and without it, the risks increase for hypertension, cardiovascular disease, stroke, diabetes, obesity, depression, anxiety, and other disorders, including COVID-19, said Dayna Johnson, Ph.D., M.P.H., an assistant professor of epidemiology at Emory University’s Rollins School of Public Health and chair of a symposium on disparities in sleep health. These disorders in turn contribute to premature mortality, she said.

Members of racial and ethnic minority groups comprised 40% of the U.S. population in 2018, according to the Pew Research Center. Sleep problems in these populations often remain undiagnosed or are undertreated, Johnson and others at the meeting said.

Johnson and colleagues examined the duration of sleep among members of racial/ethnic minority groups using self-reports, wrist-worn activity monitors known as actigraphs, and overnight sleep studies. Subjects included those who self-identified as American Indian/Alaska Native, Asian, Black, Hispanic/Latino, and/or Native Hawaiian/Pacific Islander.

They found that Black men averaged less than seven hours sleep a night, the minimum amount of sleep that specialists recommend for adults, and 82 minutes less than White women, the group with the highest sleep duration.

Neighborhood environments where many members of minorities and lower-income people often live may be a risk for poor sleep, Johnson said. For instance, bright streetlights may expose area residents to high levels of evening and nighttime light that may disrupt sleep. Crowded living conditions and noise may hamper sleep, while air pollution may contribute to asthma and sleep-related breathing disorders.

Studying Disparities in the Home

Lauren Hale, Ph.D., a professor of family, population, and preventive medicine at Stony Brook University, reported on findings from the Fragile Families and Child Well-being Study. This ongoing study follows a cohort of nearly 5,000 children born between 1998 and 2000 in 20 large U.S. cities. Roughly three-quarters of the children were born to unmarried parents. The study was designed to include a high proportion of Black and Hispanic families with nonresident fathers and parents who had not completed high school. More than half of the families had incomes below the U.S. poverty line.

Researchers have assessed the children at birth and at ages 1, 3, 5, 9, and 15 years so far, interviewing parents or caregivers at the same times.

In the age 9 wave, Hale said, they found that children of minority mothers were less likely than other children to get enough sleep. The odds of a 9-year-old child’s getting sufficient sleep were highest when parents enforced bedtimes before 9 p.m. Working in the evening or at night may prevent some parents from being able to do that, she noted.

In the age 15 wave, 800 youngsters wore a wrist actigraph to monitor sleep and waking for at least three nights. Actigraphy data, Hale said, showed that Black teens sleep 32 minutes less on school nights than White teens.

Hale said that household distractions and noise may predict sleep disruption in teens. When field investigators went to homes for a one-hour interview, they kept track of every time they were interrupted. In households with three or more interruptions, teens were sleeping 21 minutes less per night than those in homes with no interruptions.

Targeting Neighborhood Disparities

In a third study, Lu Dong, Ph.D., an associate behavioral scientist at Rand Corp. in Santa Monica, Calif., and colleagues explored neighborhood characteristics that contribute to sleep disparities as part of the Pittsburgh Hill/Homewood Research on Neighborhoods, Sleep, and Health study.

The researchers examined the prevalence and correlates of obstructive sleep apnea (OSA) in a sample of predominantly Black adults in racial/ethnic minority communities in which 32% to 35% of the households lived below the federal poverty line and encountered economic, cultural, or linguistic barriers to accessing primary health care services. Dong’s group assessed 269 adults in 2016 and 135 again in 2018. None of the participants had previously been diagnosed with OSA.

Participants slept in their own homes while wearing a home sleep apnea device that recorded the time and length of breathing interruptions. They also wore actigraphs to record sleep variables such as wake time in the night, and they answered questions about smoking, housing, and neighborhood conditions. Researchers objectively assessed neighborhood characteristics such as walkability and crime data.

The researchers found that 19% of their sample—31% of the men and 16% of the women—had moderate to severe OSA. About 85% of their study participants slept less than seven hours.

In a report in the September Sleep Medicine, the researchers said the results complement prior research showing a higher prevalence of undiagnosed OSA among Black adults, especially those living in socially disadvantaged neighborhoods.

The study also revealed a novel finding: Low neighborhood “walkability”—objective ratings of residents’ ability to safely and easily walk in the neighborhood—was associated with higher odds of having OSA, highlighting the importance of considering interventions that target both neighborhood and individual factors to reduce sleep and other health disparities. ■