Acculturation and sleep outcomes in Asian Americans and Pacific Islanders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III

Prospective Associations of COVID-19 Pandemic-Related Stressful Events With Mental and Sleep Health in a Population-Based Cohort Study of Adults With SARS-CoV-2 Infection

COVID-19 pandemic-related stressful events are associated with adverse mental health outcomes; however, prior evidence is limited due to cross-sectional designs or convenience sampling, with little focus on sleep health. We examined prospective associations of COVID-19 pandemic-related stressful events at baseline with mental health and sleep health at follow-up using a population-based cohort of Michigan adults with PCR-confirmed COVID-19. We measured COVID-19-related stressful events using the 6-item Epidemic-Pandemic Impacts Inventory (EPII), designed to assess pandemic impacts across personal and social life domains. We conducted (1) modified Poisson regression with robust standard errors for depressive symptoms, anxiety symptoms, COVID-19-related post-traumatic stress disorder (PTSD) symptoms, and poor-to-very poor sleep quality and (2) multinomial logistic regression for sleep duration (< 6, 6-9, > 9 h). We adjusted for sociodemographic, clinical, and survey factors. Our analytic samples were n = 3523 for mental health and n = 3191 for sleep health. Each additional COVID-19-related stressful event reported was associated with a higher risk of reporting depressive symptoms (adjusted risk ratio [aRR]: 1.22, 95% confidence interval [CI]:1.14-1.30), anxiety symptoms (aRR: 1.20, 95% CI: 1.14-1.27) and COVID-19-related PTSD symptoms (aRR: 1.31, 95% CI: 1.22-1.42). Each additional COVID-19-related stressful event reported was also associated with a 1.13 times higher risk of reporting poor-to-very poor sleep quality (95% CI: 1.07-1.20). In the multinomial logistic regression models, stressful events were associated with a 1.21 (95% CI: 1.06-1.37) higher risk of sleeping < 6 h relative to sleeping 6-9 h. We need social support services and programs to improve psychological and behavioural responses to COVID-19-related stressful events.

How Acculturation Shapes Sleep in Thai Women in the United States During Menopausal Transition: A Mediation and Moderation Analysis

INTRODUCTION

This study examines acculturation's impact on sleep quality, efficiency, and obstructive sleep apnea (OSA) risk among Thai women in the United States transitioning through menopause.

METHODOLOGY

This cross-sectional descriptive study recruited 120 Thai women aged 40 to 65. Questionnaires assessed sleep quality (Pittsburgh Sleep Quality Index [PSQI]), OSA risk (Berlin), menopausal symptoms (Menopause Rating), acculturation (Suinn-Lew Asian Self-Identity Scale), and anxiety (Patient-Reported Outcome Measurement Information System). Data were analyzed using bivariate correlations, multivariable regression, and mediation/moderation analyses.

RESULTS

Mean age was 51.53 (SD = 7.73) years. Most were good sleepers (PSQI <5: 80.83%) and 14.17% at high risk of OSA. Acculturation was associated with better sleep quality (B = -1.086, p = .027) and higher sleep efficiency (B = 2.425, p = .021). Mediation analysis indicated that length of stay in the United States indirectly affected sleep quality (B = -0.022, p = .026) and efficiency (B = 0.051, p = .018) via acculturation.

DISCUSSION

Acculturation significantly affects sleep among Thai women; higher acculturation correlates with better sleep quality and efficiency. Acculturation did not affect OSA risk, suggesting context-specific influences that may benefit sleep through increased social integration. Future research should explore underlying mechanisms in immigrant populations.

Toward precision sleep medicine: variations in sleep outcomes among disaggregated Asian Americans in the National Health Interview Survey (2006-2018)

STUDY OBJECTIVES

Asian Americans report higher rates of insufficient sleep than non-Hispanic Whites (NHWs). It is unclear how sleep outcomes differ among disaggregated Asian subgroups.

METHODS

The National Health Interview Survey (2006-2018) was used to analyze self-reported sleep duration and quality measures for Asian American subgroups (Chinese [n = 11,056], Asian Indian [n = 11,249], Filipino [n = 13,211], and other Asians [n = 21,767]). Outcomes included hours of sleep per day, the number of days reporting trouble falling asleep, staying asleep, waking up rested, and taking sleep medication in the past week. Subsetted multivariate logistic regression was used to assess factors impacting sleep outcomes by ethnicity.

RESULTS

29.2% of NHWs, 26.4% of Chinese, 24.5% of Asian Indians, and 38.4% of Filipinos reported insufficient sleep duration. Filipinos were less likely to report sufficient sleep duration (odds ratio 0.55, [confidence interval 95% 0.50-0.59]) and more likely to report trouble falling asleep (1.16 [1.01-1.33]) than NHWs. Chinese and Asian Indians had less trouble staying asleep (0.67 [0.58-0.77], 0.51 [0.44-0.59]) and falling asleep (0.77 [0.66-0.89], 0.72, [0.62-0.82]) than NHWs, and Asian Indians were more likely to wake feeling well rested (1.66 [1.48-1.87]). All Asian subgroups were less likely to report using sleep medications than NHWs. Foreign-born status had a negative association with sufficient sleep duration in Filipinos but a positive association in Asian Indians and Chinese.

CONCLUSIONS

Filipinos report the highest burden of poor sleep outcomes, and Asian Indians report significantly better sleep outcomes. These findings highlight the importance of disaggregating Asian ethnic subgroups to address their health needs.

CITATION

Wang RZ, Jamal A, Wang Z, et al. Toward precision sleep medicine: variations in sleep outcomes among disaggregated Asian Americans in the National Health Interview Survey (2006-2018). J Clin Sleep Med. 2023;19(7):1259-1270.

A systematic review of acculturation and sleep health among adult immigrants in the United States

The United States (US) has more immigrants than any other country in the world, with an estimated 44 million non-US-born individuals residing in the country as of 2018. Previous studies have linked US acculturation to both positive and negative health outcomes, including sleep. However, the relationship between US acculturation and sleep health is not well understood. This systematic review aims to identify and synthesize scientific studies on acculturation and sleep health among adult immigrants in the US. A systematic search of the literature was performed in PubMed, Ovid MEDLINE, and Web of Science in 2021 and 2022 with no date limiters. Quantitative studies published anytime in a peer-reviewed journal in English among an adult immigrant population with an explicit measure of acculturation and a sleep health dimension, sleep disorder, or daytime sleepiness measure were considered for inclusion. The initial literature search yielded 804 articles for review; after removing duplicates, applying inclusion and exclusion criteria, and searching reference lists, 38 total articles were included. We found consistent evidence that acculturative stress was associated with worse sleep quality/continuity, daytime sleepiness, and sleep disorders. However, we discovered limited consensus on the association of acculturation scales and acculturation proxy measures with sleep. Our review demonstrated that compared to US-born adult populations, there is a high prevalence of adverse sleep health among immigrant populations, and acculturation likely plays an important role in shaping this disparity, particularly through acculturative stress.

COVID-19 related distress and sleep health among trauma-exposed South Asians: Does generational status matter?

The COVID-19 pandemic has resulted in substantial changes in individual and socio-economic factors that may negatively impact sleep health. We examined associations between COVID-19 related distress and sleep among trauma-exposed South Asian adults in the United States. Since a health advantage among foreign-born individuals has been previously noted in the literature (the 'immigrant paradox'), we also explored if generational status (number of generations one's family has been in the U.S.) moderated associations between COVID-19 related distress and sleep health. Participants were 196 trauma-exposed South Asian adults residing in the U.S. (54% male, 63% U.S.-born citizens, average age = 34.51 years), who completed measures of generational status, COVID-19 related distress, trauma exposure, sleep-related impairment (SRI), and sleep disturbances. Greater COVID-19 distress was associated with more sleep disturbances (b = 0.15, p < 0.001) and SRI (b = 0.24, p < 0.001). Generational status was not associated with sleep, nor did it modify associations between COVID-19 distress and sleep. Findings highlight the potential importance of developing interventions to reduce stress and sleep difficulties during the pandemic. Our results did not support the immigration paradox. Future studies are needed to better understand the role of generational status on sleep health across immigrant subgroups.

Sleep disparities in Asian Americans: a comprehensive review

STUDY OBJECTIVES

This review summarizes race-based sleep health disparities between Asian Americans and other American racial groups and compares sleep outcomes between Asian American subgroups disaggregated by ethnicity and ancestral national origin. The study identifies gaps in the existing literature, analyzes barriers to studying Asian American sleep, and recommends topics for future research.

METHODS

A PubMed review of research on adult Asian American sleep was conducted. The articles included utilized actigraphy, polysomnography, and questionnaires to gather sleep health metrics. Information from these articles included data on sleep duration, sleep quality, sleep disturbances, and sleep disorders.

RESULTS

Most aggregated studies find Asian American adults experiencing lower sleep duration and poorer sleep quality compared to non-Hispanic White Americans and comparable or slightly higher sleep duration compared to Black Americans. Within Asian Americans, first-generation immigrants report better sleep quality than subsequent generations. East Asian Americans may experience better sleep outcomes compared to Southeast Asian Americans. Obstructive sleep apnea is critically underreported in South Asian Americans.

CONCLUSIONS

Significantly more research is required in Asian American sleep disparities, specifically in South and Southeast Asian Americans. Sleep disparities between Asian Americans and other racial groups are impacted by perceived discrimination, poor mental health, and cultural attitudes toward sleep. The observed within-group disparities of Asian American sleep may be attributed to socioeconomic status and generational status/acculturation. Existing barriers to research include the model minority myth and lack of disaggregated racial sleep data.

CITATION

Nandagiri V, Vannemreddy S, Spector A. Sleep disparities in Asian Americans: a comprehensive review. J Clin Sleep Med. 2023;19(2):393-402.

Sleep Health, Acculturation, and Acculturative Stress in Immigrants in the United States: A Scoping Review

INTRODUCTION

Poor sleep health has been widely associated with chronic illnesses, and immigrant populations in the United States do not experience optimal sleep, putting them at increased risk of such illnesses. The purpose of this scoping review was to synthesize published literature on the influence of acculturation and acculturative stress on the sleep health of immigrant populations in the United States.

METHOD

This scoping review was guided by Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline, and 16 research articles were included in its synthesis of results.

RESULTS

Findings indicated that immigrants in the United States have poor sleep health and that acculturation and acculturative stress may be major influencing factors. In addition, demographic and socio-contextual factors such as gender, economic status, education, and employment characteristics influenced immigrants' sleep. Race and ethnicity were additional factors influencing sleep, but the limited number of studies in this area precludes determination of which groups are most affected. Chronic stress, depressive symptoms, and language influenced immigrants' sleep health, but mixed results were observed for generational status.

DISCUSSION

Future sleep studies should include vulnerable and understudied immigrant groups and consider all socio-contextual and psychological factors potentially affecting sleep health. In health settings serving immigrant groups, nurses should emphasize screening for these factors. Also, comparative studies are needed to identify specific factors that may affect sleep health in particular immigrant ethnic groups.