Workshop Examines Role of Sleep in Health Disparities
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 recently convened a 2-day workshop examining the role of sleep in health disparities. It brought together a diverse group of academic researchers from two fields—sleep and health disparities—to strategize how to integrate research to understand the causes of sleep disparities and how to intervene.
Dr. Michael Twery, director of the National Center on Sleep Disorders Research at NHLBI, emphasized the role of sleep as a potential mediator/moderator on pathways such as oxidative stress, metabolism and brain function connecting behavioral and social determinants. Keynote speaker Dr. Margarita Alegria of Harvard Medical School discussed how to apply health disparities research frameworks to sleep disparities.
Over the past 50 years, the literature has shown that poor sleep quantity and quality correlates with higher incidence and mortality of many diseases. Sleep affects every organ system; insufficient or poor sleep has been linked to weight gain, depression, a higher risk of heart disease and diabetes, poor concentration, higher infection rates and myriad other health conditions.
Like diet and exercise, sleep is increasingly understood as a pillar of health. Differences in sleep are just beginning to be studied with health disparities populations. For example, African Americans and Latinos are more likely than whites to suffer from a lack of sleep across all ages and even within the same socioeconomic class. African Americans are also more likely to report daytime sleepiness, which is strongly correlated with a poorer quality of life and a higher risk of accidental injury.
Underlying social, cultural, environmental and biological factors have been shown to contribute to sleep deficiencies among minority and health disparity populations; these sleep deficiencies may lead to disparities in health outcomes. Sleep is often regarded as “unproductive time” in society and is thus not seen as a health priority. Research has shown that sleep patterns begin as early as in the womb and change through adulthood. Biological differences arising from sleep deprivation can cause people to react differently to triggers, such as noise and light exposure, interpersonal stressors and food choices and meal timing.
Participants discussed multi-level interventions to reduce sleep disparities, especially how clinicians, communities and policymakers can play a role to reduce disparities in sleep health. Focusing on modifiable behaviors and surrounding influences, interventions can start with educating parents and youth on the value of sleep and how to improve sleep environments. Advancing multi-level interventions that can integrate sleep as a socially patterned behavior and embracing “circadian health” will be important. Community and policy interventions must tackle external influences, such as neighborhood safety and noise pollution.
Breakout sessions facilitated discussion and development of recommendations for both understanding the causes and consequences of sleep disparities and interventions. For example, participants prioritized verifying the relationship between racism and discrimination as a driver of sleep disparities and developing population-level, culturally and developmentally sensitive interventions to promote sleep health across the life course.
The final session covered strategies to integrate the sciences of sleep and health disparities research. Life course models emphasize that, because of vulnerable developmental periods, the right intervention needs to be delivered at the right age to be effective. Holistic models that include genomic, behavioral, clinical, sociodemographic and built environment assessments will be important to advance sleep disparities research.