Harm in Sleep Disparities
Webinar Looks at Relationship Between Sleep, Housing, Cardiovascular Health
Poor housing conditions and poor sleep can damage cardiovascular health and interfere with sleep, said Dr. Dina Paltoo, NHLBI’s assistant director for scientific strategy and innovation.
“Where we live and how we’re separated is very important,” she said, opening a recent Housing, Sleep and Cardiovascular Risk webinar organized by NHLBI’s National Center on Sleep Disorders Research. “Our socioeconomic status is linked to where we live and sleep. This can give rise to our access to care and food.” Socioeconomic status also affects sleep quality and quantity, she added.
Dr. Mario Sims underscored the influence of housing on cardiovascular health. He is the Jackson Heart Study’s chief science officer and a professor in the department of medicine at the University of Mississippi Medical Center.
Recently, he led an effort to draft and publish a scientific statement from the American Heart Association. The statement reviewed and summarized research on the links between housing and cardiovascular health and overall well-being. Health is affected by four aspects of housing: stability, quality and safety, affordability and accessibility, and neighborhood environment.
“Housing is a prominent social determinant of health,” Sims said. “It should be considered when evaluating prevention efforts to reduce and eliminate racial, ethnic and socioeconomic disparities.”
The Jackson Heart Study is evaluating the causes of cardiovascular disease in African Americans. More than 5,300 men and women who live in Jackson, Miss., are enrolled. African Americans are more likely to be concentrated in areas with higher poverty. Data from the Jackson study show that areas with higher poverty rates have higher rates of heart disease.
Residents of neighborhoods with greater violence smoked cigarettes at a higher rate, had worse sleep outcomes and had an increased risk of cardiovascular disease and type 2 diabetes, particularly African-American women.
“There’s clearly a need to understand the multiplicity of socioeconomic, physical and psychosocial factors that impact racial inequities,” said Sims.
Sleep plays an important role in health, said Dr. Dayna Johnson, assistant professor in the department of epidemiology at Emory University’s Rollins School of Public Health.
The American Academy of Sleep Medicine recommends adults 18 and over get at least 7 hours of sleep per night on a regular basis. Not getting enough sleep affects a person’s heart, memory, immune system, metabolism and emotional well-being.
The most common sleep disorders are insomnia and sleep apnea. In many cases, these conditions are undiagnosed, particularly in low socioeconomic and racial/ethnic minority populations. People with sleep disorders spend more money annually on medical bills for sleep-related health problems.
“Racial and ethnic minorities, lower socioeconomic individuals and sexual minorities all are disproportionally affected by insufficient sleep and some sleep disorders,” Johnson said.
These sleep disparities can be attributed to social determinants such as discrimination, inconsistent work schedules and stress, as well as environmental factors at the housing and neighborhood level. Examples include inopportune light exposure, toxins, adverse temperature, noise and violence. Each of these factors consistently affects sleep duration and quality.
She noted that a few studies indicate racial sleep disparities are reduced by at least 50 percent when accounting for neighborhood environment. Another study she led found that those who live in mobile homes or trailers had higher odds of worse sleep compared to those living in an apartment or house.
To improve the sleep of people who will live in the homes they design, Johnson suggested that developers incorporate features that promote sleep health, such as insulation, ventilation and sound-proofing. Individuals can hang curtains to prevent artificial light from entering a bedroom and avoid screen-time before bed. Public officials could design and implement policies that eliminate homelessness and housing insecurity.
“Context matters,” Johnson concluded. “It’s important to think about how individuals are nested in social relationships, living conditions, neighborhoods and communities, our built environment, institutions and social and economic policies.”