Sleep and its Relationship to Racial and Ethnic Disparities in Cardiovascular Disease

Abstract

There are substantial racial/ethnic disparities in cardiovascular disease in the U.S., but few mechanisms have emerged as feasible intervention targets. A growing body of research suggests that racial/ethnic differences in sleep deficiency, including extreme sleep duration, sleep-disordered breathing, and insomnia, may help explain disparities in cardiovascular disease. However, little is known about the mechanisms underlying racial/ethnic disparities in sleep. In this article, we review the extant literature on sleep and cardiovascular outcomes (e.g., hypertension, stroke, cardiovascular disease) and racial/ethnic differences in these relations. We also discuss possible mechanisms that might help explain racial/ethnic sleep disparities, including neighborhood disadvantage, psychosocial and occupational stressors, acculturation, and treatment access and adherence. More research is needed to establish causal linkages among race/ethnicity, sleep, and these mechanisms, but existing evidence suggests that targeting these factors in interventions may reduce racial/ethnic sleep disparities and improve primary prevention of cardiovascular disease among all racial/ethnic groups.

Exposure to self-reported occupational noise and diabetes – A cross-sectional relationship in 7th European social survey (ESS7, 2014)

“…Another issue, pertinent to most occupational epidemiology studies, is the healthy worker/survivor effect [44] workers coping ineffectively with noise stress might have changed their job or even experienced a fatal event before the onset of diabetes, while diabetes itself could have Chinese sawmill workers had substantively higher risk of noise-attributed hypertension than those from the white race [29]. Since participants' noise exposure did not differ across ethnic groups, differences in the effect size could be attributed to some unaccounted for residual confounding such as nutritional habits, religious practices, access to healthcare [30], environmental sensitivity or sleep quality [31,32], which could be explored by additional analyses of the dataset. The literature also suggests ethnic and racial differences in the prevalence of hearing loss and hearing threshold levels [33,34], which could moderate the effects of noise.…”

Reducing health disparities: the role of sleep deficiency and sleep disorders

“…This delineation will likely require consideration of interactions among multi-level factors, and will be critical in identifying modifiable factors for intervention strategies to reduce disparities in sleep health. For example, occupational and psychosocial stress, level of acculturation, neighborhood conditions, work-life balance, co-morbid medical conditions, and cultural beliefs and knowledge regarding sleep may all contribute to racial/ethnic differences in sleep(19–21). Most findings from population-based surveillance tools are based on self-reported sleep characteristics and symptoms, raising the possibility that cultural differences in reporting health information could account, in part, for some of the disparities identified in sleep health.…”

Prevalence of daytime sleeping in the working population from estimates of nocturnal work shift

“…The findings support previous work highlighting that socioeconomically vulnerable populations (e.g., Non-Hispanic-Blacks) may be at greater risk for sleep abnormalities, [17][18][19] a sub-group of individuals known to have greater environmental stressors throughout the lifecourse. [20][21][22] Sleep research should continue to study the relatively small (≈ 3.3%), but objectively large (≈ 4.3 million), understudied population of individuals who attempt to complete all their sleep during sunlight hours. This group of sleepers may provide unique insight on how sunlight, daytime noise, and atmospheric temperature play a role in the etiology of disease over the lifecourse.…”