Racial/ethnic disparities in sleep health and health care: importance of the sociocultural context

Abstract

Sleep may play an important role in health disparities. Indeed, several studies have shown that racial/ethnic minorities in the United States are more likely to report short (≤6 hours) sleep durations, relative to non-Hispanic white.1,2 Furthermore, several studies have shown that although sleep complaints may be difficult to assess in minority populations,3 minorities tend to be at increased risk for poor sleep quality.4,5 This is important because habitual short sleep duration is associated with obesity,6 cardiovascular disease,7 diabetes,8 and mortality.9 Several studies have also shown poor health outcomes associated with poor sleep quality.10 Furthermore, several studies have suggested that the relationship between sleep duration and these health outcomes differs across racial/ethnic groups. For example, data from the National Health and Nutrition Examination Survey and National Health Interview Survey data sets have evidenced that relationships between sleep duration and obesity, diabetes, hypertension, and hyperlipidemia depend on individuals race/ethnicity.11,12 It is also likely that race/ethnicity influences relationships between sleep duration and plasma levels of C-reactive protein13 as well as relationships between sleep apnea and risk of sleep apnea.14 Taken together, this literature suggests that short sleep duration and/or poor sleep quality are associated with adverse health outcomes, racial/ethnic minorities are at increased risk for short sleep duration and/or poor sleep quality, and the relationships between sleep and health outcomes may be moderated by race/ethnicity. Thus, the issue of sleep health disparities represents an important area of research. Nearly 3 decades ago, the US Secretary's Task Force on Black and Minority Health concluded that “despite the unprecedented explosion of scientific knowledge and the phenomenal capacity of medicine to diagnose, treat, and cure disease, blacks, Hispanics, Native Americans, and those of Asian/Pacific Islander heritage have not benefited fully or equitably from the fruits of science or from systems responsible for translating and using health sciences technology.”15 Yet, for many reasons, less is known about racial/ethnic health and health care disparities in sleep medicine. Moreover, potential cultural influences on sleep disorders, sleep practices, and habitual sleep duration have received little attention in the adult sleep literature. The main purpose of this review is to (1) examine potential ramifications of inadequate sleep in a multicultural context; (2) identify cultural variations between patient and provider in the delivery of sleep care, borrowing from the medical and psychosocial literature; and (3) propose potential strategies to address sleep disparities. We conclude with an agenda for advancing health disparities research in sleep medicine.