Racial/Ethnic and Sex/Gender Differences in Sleep Duration Trajectories From Adolescence to Adulthood in a US National Sample

Longitudinal trends of sleep services for veterans with and without serious mental illness in VA electronic health records

Sleep problems commonly co-occur with serious mental illnesses (SMI) and are associated with negative outcomes, though may be underrecognized and undertreated. This study examined whether clinical services for sleep disorders among Veterans with and without SMI changed during the past decade. The sample included Veterans with a diagnosed sleep disorder in VA VISN 4 (Pennsylvania and sections of Ohio, New Jersey and Delaware) electronic health record data from 2011 to 2019 (N = 77,898). Results revealed that, across 9 years of data, half of Veterans received no sleep services, but among those that did, sleep medications were most common., Notably, Veterans with SMI and sleep disorders were more likely than those without SMI to receive any sleep services, but the proportion of all Veterans receiving sleep services declined across the study period. Results from this study demonstrate that the needs of Veterans with SMI and sleep disorders are met equally well as those of Veterans without SMI, but there remains a large unmet need for all Veterans with sleep disorders, half of whom did not receive any services. Future work should investigate provider and patient perspectives regarding barriers and facilitators to engaging with sleep services, particularly services other than medication.

Multidimensional Sleep Health: Definitions and Implications for Cardiometabolic Health: A Scientific Statement From the American Heart Association

Poor sleep health is associated with cardiometabolic disease and related risk factors, including heart disease, stroke, elevated blood pressure and lipid levels, inflammation, glucose intolerance, obesity, physical inactivity, poor diet, unhealthy substance use, poor mental health, and increased all-cause and cardiovascular mortality, and is associated with social determinants of cardiovascular health and health disparities. Therefore, sleep duration has been recognized by the American Heart Association as one of Life's Essential 8. Although chronic sleep duration is the sole metric used in Life's Essential 8, sleep health represents a multidimensional construct. This scientific statement outlines the concept of multidimensional sleep health (sleep duration, continuity, timing, regularity, sleep-related daytime functioning, architecture, and absence of sleep disorders) as it applies to cardiometabolic health. Considerations of how these dimensions are related to cardiometabolic health and patterned by sociodemographic status are explained, and knowledge gaps are highlighted. Additional data are needed to understand better how these various dimensions of sleep should be assessed and how interventions targeting sleep health in clinical and community settings can be leveraged to improve health.

Sleep irregularity is associated with night-time technology, dysfunctional sleep beliefs and subjective sleep parameters amongst female university students

Sleep irregularity has been linked to multiple deleterious consequences in clinical populations or community adults and adolescents, but little is known about young adults. In this study, we explored the relationships between two measures of sleep regularity and a wide range of factors (lifestyle behaviors, subjective sleep, clinical outcomes, and academic performance) in a sample of female, university students in the United Arab Emirates. A total of 176 participants were recruited. Objective estimates of sleep-wake patterns were obtained using seven-day wrist actigraphy and data were used to calculate daily sleep regularity with the Sleep Regularity Index (SRI) and weekly sleep regularity with the social jetlag (SJL). Subjective sleep measures were also acquired using the Pittsburgh Sleep Quality Index (PSQI), Dysfunctional Beliefs and Attitudes about Sleep (DBAS), and daytime napping frequency. Self-reported night-time technology use frequency was ascertained using the Technology Use Questionnaire (TUQ). Psychological health was assessed using the Hospital Anxiety and Depression Scale. Objective physical health measurements for body mass index, fasting blood glucose and blood pressure were obtained. No significant associations emerged between sleep regularity and psychological physical health, or academic performance. However, significant relationships were detected between SRI and daytime napping frequency (p-value = 0.0017), PSQI (p-value = 0.0337), and DBAS (p-value = 0.0176), suggesting that daily irregular sleep patterns are associated with more frequent daytime napping, greater dysfunctional sleep beliefs, and poorer subjective sleep quality. Conversely, SJL was significantly associated with the DBAS (p-value = 0.0253), and the TUQ (p-value = 0.0208), indicating that weekly irregular sleep patterns are linked to greater dysfunctional sleep beliefs and increased nighttime technology use. In conclusion, efforts to educate and cultivate sustainable and consistent sleep-wake patterns amongst university students are needed, which can be achieved by raising awareness, promoting good sleep health habits, and minimizing excessive bedtime technology.

Disparities in sleep among diverse adolescents in two large statewide samples: A need for intersectional interventions

OBJECTIVES

Examine very short sleep among adolescents across multiple intersecting social positions and experiences of sexual orientation-based bullying and cyberbullying in two statewide samples.

METHODS

A harmonization of two large statewide school-based datasets from grades 9-12 (2019 Minnesota Student Survey, and 2018-2019 California Healthy Kids Survey) was utilized for the analysis (N = 379,710). Exhaustive chi-square automatic interaction detection (an approach for quantitative intersectionality research) explored variability in very short sleep (≤5 hours/night) among adolescents from multiple intersecting social positions (race/ethnicity, gender identity, sexual orientation, and sex assigned at birth), grade, state, and two types of bullying experiences (sexual orientation-based bullying and cyberbullying). Intersectional groups reporting the highest prevalence of very short sleep were identified. We compared very short sleep rates among adolescents from the same social positions who experienced bullying with those who did not experience bullying.

RESULTS

Very short sleep was common among this sample of adolescents (19.2%), especially among those holding multiple marginalized social positions (36.9%-51.4%). Adolescents who were transgender or gender diverse or questioning gender identity, and with minoritized sexual and racial/ethnic identities were overrepresented among high prevalence groups of very short sleep. Bullying experiences were reported by all highest prevalence groups. Adolescents who were bullied had 24.9%-51.3% higher rates of very short sleep than adolescents from the same intersecting social positions who were not bullied.

CONCLUSIONS

Very short sleep is pervasive among marginalized adolescents. Findings suggest that victimization contributes to adolescents' very short sleep rates. Individual-level interventions may fall short of promoting better sleep among adolescents; systemic interventions addressing bullying are needed.

CLINICAL TRIAL REGISTRATION

N/A.

The impact of race, ethnicity, and socioeconomic status on early adolescent sleep disturbances for youth exposed to adverse childhood experiences

BACKGROUND

Adverse childhood experiences (ACEs) may increase the risk for adolescent sleep disturbances, though the impact of race, ethnicity, and socioeconomic status (SES) remains unclear.

OBJECTIVE

We sought to determine the direct and moderating impact of race, ethnicity, family SES, and community SES on sleep disturbances across early adolescence for ACE-exposed youth.

PARTICIPANTS AND SETTING

This secondary analysis used longitudinal Adolescent Brain Cognitive Development Study® data (2016-2022) from youth who experienced ≥1 ACE by age 9-10 years.

METHODS

Clinically significant sleep disturbances were identified from the annual parent-reported Sleep Disturbances Scale for Children. Parents reported youths' race, ethnicity, family SES, and community SES at baseline. Multilevel mixed effects logistic regression modeling examined the impact of race, ethnicity, and SES on sleep disturbances over four years among ACE-exposed youth. Adjusted odds ratios with 95 % confidence intervals are presented (adj. OR [95 % CI]).

RESULTS

Among 6661 youth with ACE exposure, 2402 (36.1 %) had clinically significant sleep disturbances at baseline. Multiracial (versus White) youth were 27 % likelier to have clinically significant sleep disturbances over time (adj. OR 1.27 [95 % CI 1.01, 1.59]). Similar results were found for youth exposed to ≥2 family financial adversities (adj. OR 1.50 [95 % CI 1.19, 1.90]). There were no effects of community SES, nor interaction effects of race, ACEs, or SES on sleep disturbances.

CONCLUSION

While Multiracial youth may experience additional stressors which affect sleep disturbances, regularly assessing family environments and supporting all families to meet basic needs may positively impact adolescent sleep.

Corresponding Changes in Sleep and Discrimination: A Three-year Longitudinal Study Among Ethnically/Racially Diverse Adolescents

Although research has established the immediate, detrimental impact of discrimination on sleep, how changes in experiences of discrimination may be related to changes in sleep duration over multiple years is less clear. This three-year longitudinal study investigated: (1) intercept-only and linear trajectories of sleep and everyday discrimination across three years of high school; (2) ethnic/racial differences in these trajectories; and (3) the associations between changes in sleep and changes in everyday discrimination. The sample consisted of ethnically/racially minoritized adolescents from five northeast U.S. public high schools (n = 329; 70% female, 30% male, 0% non-binary; 42% Asian, 21% Black, 37% Latiné; Mage = 14.72, SD = 0.54). Latent growth curve models found that both sleep duration and everyday discrimination declined linearly throughout the first three years of high school and varied by race/ethnicity. Asian adolescents reported longer sleep duration in the 9th grade relative to Black and Latiné adolescents but underwent a significant decline such that these differences were no longer significant in the 10th and 11th grades. In addition, Black and Latiné, but not Asian, adolescents reported a significant decline in discrimination from the 9th-11th grades. Although average sleep duration declined for the entire sample, slower declines in discrimination were associated with faster decreases in sleep duration. This was particularly salient among Black adolescents. The current study contributes to research on ethnic/racial disparities in sleep by highlighting that everyday discrimination can have both an immediate and cumulative detrimental impact on sleep duration.

Associations between sleep, energy balance, and obesity markers over 6 months in Black emerging adults-pilot study findings from the Sleep, Health Outcomes, and Body Weight (SHOW) study

Insufficient sleep (short sleep duration and poor sleep quality) is associated with obesity risk. Emerging adults (ages 18-28 years) have a greater risk of excess weight gain and insufficient sleep, and these risks are higher in Black individuals. Using a measurement burst design, we assessed associations between sleep with energy balance components and obesity marker changes over 6 months in 15 Black emerging adults (12 females; age: 21 ± 2.5 years; body mass index: 25.7 ± 4.5 kg/m2; body fat: 25.8 ± 11.9%). Since our sample was predominantly female (80%), we repeated our analyses for females only. Participants completed the following measurements at baseline (BLN) and 6 months later (6MO): 7 days of actigraphy-based sleep and physical activity energy expenditure (EE) and 2 nights of in-home polysomnography-based sleep; resting EE and thermic effect of food with indirect calorimetry; ad libitum energy intake (EI) via self-reported methods over 4 days and directly measured over 3 days with provided meals. Body weight (2.6 kg, p = 0.01) and waist circumference (2.4 cm, p = 0.03) increased from BLN to 6MO. Changes in actigraphy-based sleep duration were associated with changes in body weight (β = 0.03, standard error (SE) = 0.02, p = 0.04) and fat mass (β = 0.07, SE = 0.03 p = 0.03) in females only. Greater rapid eye movement sleep duration was associated with increases in resting EE (β = 2.24, SE = 0.84, p = 0.02). Greater slow-wave sleep was associated with increases in self-reported EI (β = 18.34, SE = 4.7, p < 0.01). Sleep may impact components of energy balance and risk of weight gain in Black emerging adults. Additional research is needed to confirm our pilot findings.

Association of Exposure to Interpersonal Racism and Racial Disparities in Inadequate Sleep Risk

OBJECTIVE

To examine the association between caregiver-report of their child's inadequate sleep and exposure to interpersonal racism within racially minoritized subpopulations.

STUDY DESIGN

We conducted cross-sectional analysis among racially minoritized 21 924 school-aged children and 27 142 adolescents using a National Survey of Children's Health sample from 2016 through 2021. Multivariable logistic regression models were fit to estimate predicted probabilities for the adjusted associations between caregiver-report of their child's inadequate sleep and prior exposure to interpersonal racism.

RESULTS

In bivariate models, caregiver report of child exposure to interpersonal racism was significantly associated with a higher probability of inadequate sleep within non-Hispanic Asian American/Pacific Islander school-aged children, Hispanic adolescents, and non-Hispanic multiracial adolescents. After adjusting for covariates, only the association within Hispanic youth remained significant though attenuated. Unexpectedly, non-Hispanic Black school-age children exposed to racism had a lower probability of inadequate sleep than non-Hispanic Black children without exposure to racism after adjusting for covariates.

CONCLUSIONS

Nationally representative pooled data that showed caregiver-report of Hispanic adolescents' inadequate sleep was associated with their exposure to interpersonal racism, although an association with inadequate sleep was not found in other racially minoritized subpopulations. Examining within-race associations helps to assess more accurately risk and target efforts that seek to address racism-related stress among racially minoritized subpopulations.

Sleep patterns in adolescents and associations with substance use

OBJECTIVES

Good sleep during adolescence is crucial for maintaining physical and psychological health; however, sleep disturbance during this period may contribute to health risks, such as substance use. This study aimed to identify the latent sleep patterns across male and female adolescents, and their association with drug use.

METHOD

A cross-sectional study was conducted involving 1391 high school students (aged 15-17; 56.4% female). Participants completed the brief Pittsburgh Sleep Quality Index alongside other sleep measures, and the Timeline Follow-Back and Drug Use History Questionnaire to measure substance use. A multiple-group latent class analysis was used to identify sleep patterns across sexes, and pairwise Logistic Regression models to compare their association with substance use.

RESULTS

Four sleep patterns were identified with varying degrees of sleep difficulties: "Good Sleep" (43.3%), "Night Awakenings" (31.8%), "Poor Efficiency and Sleep Onset" (9.4%), and "Poor Sleep" (15.5%). Female adolescents were more likely to belong to Poor Sleep and Poor Efficiency and Sleep Onset patterns, and male adolescents to Good Sleep. Likewise, binge drinking and using alcohol for a longer period were associated with experiencing Poor Efficiency and Sleep Onset (OR=1.03 and 2.3, respectively); smoking tobacco within the past month was linked to Night Awakenings (OR=2.2); and using cannabis or illegal drugs to the Poor Sleep pattern (OR=2.4 and 2.6, respectively).

CONCLUSIONS

Varied sleep difficulties exist among adolescents that significantly correlate with different aspects of drug use. Targeted interventions that address both sleep and drug prevention are recommended.

Reproductive hormones and sex chromosomes drive sex differences in the sleep-wake cycle

There are well-documented gender differences in the risk and severity of sleep disorders and associated comorbidities. While fundamental sex differences in sleep regulatory mechanisms may contribute to gender disparities, biological responses to sleep loss and stress may underlie many of the risks for sleep disorders in women and men. Some of these sex differences appear to be dependent on sex chromosome complement (XX or XY) and the organizational effects of reproductive hormones. Reproductive development plays a critical role in the ability of sex chromosomes and reproductive hormones to produce sex differences in sleep and wakefulness. Rodent models reveal that reproductive hormones drive many but not all sex differences in sleep-wake architecture. The ability of reproductive hormones to alter sleep are often dependent on responses to sleep loss and stress. However, in the absence of reproductive hormones (in gonadectomized rodents) sex differences in sleep amount and the ability to recover from sleep loss persist. The suprachiasmatic nucleus (SCN) and the ventrolateral preoptic nucleus (VLPO) of the hypothalamus play crucial regulatory roles in mediating the effects of reproductive hormones on the sleep-wake cycle. Taken together, the work reviewed here reveals that the reproductive hormone environment and sex chromosome complement may underlie gender disparities in sleep patterns and the risk for sleep disorders.

Mechanisms Linking Social Media Use and Sleep in Emerging Adults in the United States

Social media use is associated with poor sleep outcomes. We aimed to extend previous research by examining how measures of social media use would affect two sleep characteristics: sleep quality and insomnia symptoms. In addition, we tested a serial mediation model linking social media use to sleep through increases in negative social comparison and pre-sleep cognitive arousal. Participants were 830 emerging adults (ages 18-30) who were recruited for an online survey study in February 2024. The sample was 63.1% female, with an average age of 24. We examined three measures of social media use: duration (minutes of daily use), frequency (number of weekly visits to social media platforms), and emotional investment (attachment to and integration of social media into daily life). Consistent with our hypothesis, greater emotional investment in social media and more frequent social media use were associated with poorer sleep quality and greater insomnia severity. We also found evidence supporting our hypothesized serial mediation model: emotional investment in social media and more frequent social media use were associated with increased negative social comparison, which subsequently increased pre-sleep cognitive arousal, which then led to poorer sleep outcomes. Our findings suggest that negative social comparison and pre-sleep cognitive arousal are important mechanisms linking social media use to poor sleep outcomes. Future studies should aim to test this serial mediation model using longitudinal data and experimental methods.

Association of Sleep Duration with Risk of All-Cause and Cause-Specific Mortality Among American Adults: A Population-Based Cohort Study

Objective

To examine potential factors affecting sleep duration and explore its association with the risk of mortality among adults in the United States.

Methods

The study population consisted of adults aged 26 to 79 years who participated in the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2016. Sleep duration was classified into three categories: short (<7 hours), optimal (7-8 hours), and long (≥9 hours). The associations between sleep duration and both all-cause mortality and cause-specific mortality (including heart disease, tumors, cerebrovascular disease, and others) were examined in the overall population and subgroups using weighted Cox regression models. Dose-response associations between sleep duration and risk of all-cause mortality were explored using restricted cubic spline (RCS) analyses. Additionally, a multinomial logistic regression analysis was conducted to investigate potential factors that influence sleep duration in adults.

Results

The study included a total of 24,141 subjects, with a population-weighted mean age of 48.93 years. Over 30% of the subjects exhibited unhealthy sleep habits. Fully adjusted models revealed that both short sleep duration (HR=1.169, 95% CI 1.027-1.331) and long sleep duration (HR=1.286, 95% CI 1.08-1.531), were associated with an increased risk of all-cause mortality. The RCS curves showed a U-shaped relationship between sleep duration and risk of all-cause mortality. Subgroup analyses showed a significant association between poor sleep patterns and all-cause mortality among adults aged 26-64 years, males, and non-Hispanic whites. Furthermore, multinomial logistic regression identified several predictors associated with short and long sleep durations.

Conclusion

Both short and long sleep duration are associated with an increased risk of all-cause mortality, with a U-shaped dose-response relationship. It is imperative to implement appropriate primary prevention strategies aimed at monitoring and providing health education to populations at risk of developing unhealthy sleep patterns.

Anxiety, Sleep Problems, and Vigorous Physical Activity: Bidirectional Associations from Early Adolescence to Early Adulthood in Swedish Adolescents

Anxiety symptoms and sleep problems typically emerge during adolescence and are frequently intertwined. However, there is a dearth of knowledge concerning their reciprocal influence and whether physical activity might play a protective role in this relationship. The present study aims at filling this gap exploring also the moderating role of sex. 915 13-year-old Swedish adolescents (56% girls) answered a survey conducted four times: at ages 13 (T1), 16 (T2), 19 (T3), and 22 (T4). A random intercept cross-lagged panel model was used. At within-levels, sleep problems and anxiety symptoms had a bidirectional positive association in middle adolescence. Vigorous physical activity and anxiety symptoms showed a reciprocal negative association from middle adolescence. Vigorous physical activity and sleep problems were reciprocally associated only in late adolescence. Associations were the same for girls and boys. This study demonstrated that the relations between anxiety symptoms, sleep problems, and vigorous physical activity cannot be understood without adopting a developmental perspective and that middle adolescence is a crucial period to plan interventions to reduce anxiety symptoms and sleep problems.

Adherence to sleep recommendations is associated with higher satisfaction with life among Norwegian adolescents

BACKGROUND

Sleep plays a crucial role in the health and well-being of adolescents; however, inadequate sleep is frequently reported in numerous countries. This current paper aimed to describe sleep duration, factors impacting sleep, consequences of insufficient sleep and satisfaction with life in Norwegian adolescents, stratified by sex and by adherence to the 8-hour sleep recommendation, and to examine potential associations between adherence to the 8-hours sleep recommendation and satisfaction with life.

METHODS

This is a cross-sectional study using data from the Norwegian Ungdata Survey, collected in 2021. Adolescents from five Norwegian counties were included, comprising a total of 32,161 upper secondary school students. Study variables were collected through an electronic questionnaire administered during school hours and all data are anonymous. Descriptive data of sleep patterns are presented, and linear regressions were conducted adjusting for SES, perceived stress, physical activity level, over-the-counter analgesics use, grade level and screen time.

RESULTS

73% of adolescents did not adhere to the 8-hours of sleep recommendation per night, with similar results for girls and boys. 64% reported tiredness at school (minimum 1-2 days weekly) and 62% reported that screen time negatively affected their ability to sleep. 23% reported that gaming affected their sleep, with a higher prevalence in boys than girls. Satisfaction with life score was 7.0 ± 1.9 points (out of 10) for the total sample, with higher scores for boys (7.3 ± 1.8 points) than girls (6.9 ± 1.9 points). Regressions revealed a positive association with satisfaction with life (B = 0.31, 95% [0.15 to 0.48]) in adolescents adhering to sleep recommendation of 8h compared to the ones not adhering to the sleep recommendation.

CONCLUSIONS

Most Norwegian adolescents fail to adhere to the 8-hours of sleep recommendation and the majority feel tired at school or during activities. More than half of adolescents reported that screen time negatively affected their ability to sleep. Adhering to the sleep recommendation was associated with higher life satisfaction. Our findings highlight the importance of sufficient sleep in adolescents, while future research is needed to examine other sleep related measures on adolescents´ satisfaction with life.

Perceived childhood neighborhood safety and sleep health during childhood and adulthood among a cohort of African American women

OBJECTIVE

To investigate associations between perceived childhood neighborhood safety and sleep over the life course.

METHODS

Among a cohort of 1693 Black/African American women aged 23-35 years at enrollment (2010-2012), participants recalled neighborhood safety (safe vs. unsafe) when they were 5, 10, and 15 years old. Participants' mothers/caregivers and participants reported sleep-related health behaviors at age 5. We used ordinal logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for sleep-related health behaviors (i.e., rarely/never or sometimes vs. mostly/always going to bed by 8:00 p.m., bed in a quiet room, bed in a dimly lit or unlit room), separately. Adulthood sleep duration and insomnia symptoms were reported at enrollment and over three follow-up periods. We applied generalized estimating equations to log binomial regression models to estimate relative risks (RR) for adulthood sleep characteristics.

RESULTS AND CONCLUSIONS

Four percent of participants reported an unsafe neighborhood at age 5 years, only, and 12% reported an unsafe neighborhood at all ages. Participants in perceived unsafe vs. safe neighborhoods at age 5 had higher odds of poor sleep-related health behaviors (e.g., rarely/never or sometimes going to bed in a quiet room: OR = 1.73 [1.27-2.35]). Participants in perceived unsafe vs. safe neighborhoods throughout childhood had higher risk of short sleep (RR = 1.10 [1.02-1.18]) and insomnia symptoms (RR = 1.07 [1.00-1.15]) during adulthood after adjustment for life course socioeconomic characteristics and adulthood health behaviors and characteristics. Perceived unsafe childhood neighborhood was associated with poorer sleep over the life course and may serve as an early intervention target.

Neighborhood Light at Night and Noise Levels, and Long-Term Sleep Trajectories in the Southern Community Cohort Study

While light at night (LAN) and noise levels have been linked to suboptimal sleep outcomes, little is known about the link between these factors and long-term suboptimal sleep trajectories. The current study examined the association of neighborhood LAN and nighttime noise with long-term sleep trajectories in a cohort of Black individuals and White individuals predominantly from low-income communities. We used data from the Southern Community Cohort Study (N = 28,759 Black individuals and 16,276 White individuals). Sleep duration was self-reported at baseline and after an average of five years of follow-up, based on which we constructed nine sleep trajectories: normal-normal (optimal, reference), short-short, long-long, short-long, long-short, normal-short, normal-long, short-normal, and long-normal. LAN and nighttime noise were derived from satellite imagery and model-based estimates, respectively. Multinomial logistic regression was used to determine the relationship between LAN and noise exposures and sleep trajectories. Higher exposures to LAN and nighttime noise were associated with multiple suboptimal long-term sleep trajectories. In the total sample, higher LAN was associated with higher odds of long-long (OR Q5 vs. Q1 = 1.23 (CI = 1.02, 1.48)) and long-short (OR = 1.35 (CI = 1.06, 1.72)) trajectories, while higher nighttime noise was associated with short-short (1.19 (1.07, 1.31)), long-short (1.31 (1.05, 1.64)), and normal-song (1.16 (1.01, 1.34)) trajectories. Black and White individual-specific results showed qualitatively similar patterns between Black individuals and White individuals, although we also observed suggestive evidence for Black-White individual differences. In conclusion, elevated LAN and nighttime noise levels were associated with various suboptimal long-term sleep trajectories. However, it is noteworthy that the light and noise measures in our study may not accurately reflect individual-level exposures, and residual confounding from other factors is a concern. Future studies should use more accurate exposure measurements, collect information on and control for a wider range of factors, and examine whether reductions in neighborhood light and noise levels may contribute to improved long-term sleep health.

Eyes Wide Open: Sleep as a Potential Contributor to Racial and Ethnic Disparities in Cancer

U.S. racial and ethnic minoritized groups face disproportionate cancer burdens compared to White Americans. Investigating modifiable factors, such as sleep, that are socially patterned and inequitably distributed by race and ethnicity may advance understanding of cancer disparities and provide intervention opportunities. Emerging data suggest poor sleep health is associated with cancer. Yet, its contribution to racial and ethnic cancer disparities is understudied. In this narrative review, we explored the sleep-cancer relation through a disparities lens. We (i) summarized literature reporting on associations between sleep and cancer among racial and ethnic minority populations; (ii) examined potential sleep-cancer mechanisms; and (iii) discussed future directions. We identified five studies reporting on sleep-cancer associations among minoritized groups. Poor sleep health was associated with aggressive breast cancer among Black women, increased breast cancer risk among Asian women, and increased risk of breast and total cancer among Hispanic/Latinx Americans. Sleep and cancer disparities have similar socioeconomic and behavioral determinants, suggesting racial and ethnic minoritized groups may be vulnerable to poor sleep health and its adverse health impacts. Evidence indicates that the sleep-cancer disparities relation is an emerging, but important area of research that warrants further investigation, as sleep may be an avenue for reducing cancer disparities.

Sleep-Related Predictors of Risk for Alcohol Use and Related Problems in Adolescents and Young Adults

PURPOSE

Growing evidence supports sleep and circadian rhythms as influencing alcohol use and the course of alcohol use disorder (AUD). Studying sleep/circadian-alcohol associations during adolescence and young adulthood may be valuable for identifying sleep/circadian-related approaches to preventing and/or treating AUD. This paper reviews current evidence for prospective associations between sleep/circadian factors and alcohol involvement during adolescence and young adulthood with an emphasis on the effects of sleep/circadian factors on alcohol use.

SEARCH METHODS

The authors conducted a literature search in PsycInfo, PubMed, and Web of Science using the search terms "sleep" and "alcohol" paired with "adolescent" or "adolescence" or "young adult" or "emerging adult," focusing on the title/abstract fields, and restricting to English-language articles. Next, the search was narrowed to articles with a prospective/longitudinal or experimental design, a sleep-related measure as a predictor, an alcohol-related measure as an outcome, and confirming a primarily adolescent and/or young adult sample. This step was completed by a joint review of candidate article abstracts by two of the authors.

SEARCH RESULTS

The initial search resulted in 720 articles. After review of the abstracts, the list was narrowed to 27 articles reporting on observational longitudinal studies and three articles reporting on intervention trials. Noted for potential inclusion were 35 additional articles that reported on studies with alcohol-related predictors and sleep-related outcomes, and/or reported on candidate moderators or mediators of sleep-alcohol associations. Additional articles were identified via review of relevant article reference lists and prior exposure based on the authors' previous work in this area.

DISCUSSION AND CONCLUSIONS

Overall, the review supports a range of sleep/circadian characteristics during adolescence and young adulthood predicting the development of alcohol use and/or alcohol-related problems. Although sleep treatment studies in adolescents and young adults engaging in regular and/or heavy drinking show that sleep can be improved in those individuals, as well as potentially reducing alcohol craving and alcohol-related consequences, no studies in any age group have yet demonstrated that improving sleep reduces drinking behavior. Notable limitations include relatively few longitudinal studies and only two experimental studies, insufficient consideration of different assessment timescales (e.g., day-to-day vs. years), insufficient consideration of the multidimensional nature of sleep, a paucity of objective measures of sleep and circadian rhythms, and insufficient consideration of how demographic variables may influence sleep/circadian-alcohol associations. Examining such moderators, particularly those related to minoritized identities, as well as further investigation of putative mechanistic pathways linking sleep/circadian characteristics to alcohol outcomes, are important next steps.

Race and sex differences in the longitudinal changes in multidimensional self-reported sleep health characteristics in aging older adults

OBJECTIVES

We examined within-individual changes in self-reported sleep health as community-dwelling older adults age as well as potential differences in these changes by self-reported sex and racial identity.

METHODS

Participants were from the United States and enrolled in the Rush Memory and Aging Project, Minority Aging Research Study, or Religious Orders Study (N = 3539, 20% Black, 75% female, mean 78years [range 65-103]), and they received annual, in-person clinical evaluations (median 5 visits [range 1-27]). A sleep health composite score measured the number of poor sleep characteristics among satisfaction, daytime sleepiness, efficiency, and duration. Mixed effects models estimated associations of age, race, sex, and their interactions on the composite and individual sleep measures, accounting for key confounders.

RESULTS

As they aged, Black participants shifted from reporting two poor sleep characteristics to one poor sleep characteristic, while White participants shifted from one poor characteristic to two. Regardless of age, sex, and race, participants reported that they "often" felt satisfied with their sleep and "sometimes" had trouble staying asleep. Females over age 85 and males of all ages reported the most daytime sleepiness, and older White participants (>age 90) reported the most difficulty falling asleep.

CONCLUSIONS

Although self-reported sleep characteristics were typically stable across age, identifying race and sex differences in self-reported sleep health can help guide future research to understand the mechanisms that underlie these differences.

Construction of a model for adolescent physical and mental health promotion based on the multiple mediating effects of general self-efficacy and sleep duration

We developed a model for promoting adolescent physical and mental health (MH) to investigate the integrated pathways of physical activity (PA), MH, general self-efficacy (GSE), and sleep duration (SD) promotion among adolescents in China. The research hypotheses were tested using questionnaires, descriptive statistics, and validated factor analysis. The mean age of the respondents was 14.94 ± 1.76 years, the PA level was 2.49 [95% confidence interval (CI): 2.46-2.53], the GSE score was 2.60 (95% CI: 2.57-2.64), the SD was 436.52 min/day (95% CI: 432.89-440.15), and the total mean MH score was 1.72 (95% CI: 1.69-1.76) (model fitness index: χ2/df = 1.295, comparative fit index = 0.999, Tucker-Lewis index = 0.997, root mean square error of approximation = 0.014, standardized root mean square residual = 0.007). The SD accounted for 46.85% of the mediating effect. The adolescents exhibited moderately low PA levels, severe SD deficits, and high rates of overall MH abnormalities. Consequently, the constructed model for promoting adolescent physical health and MH was confirmed to be reliable; GSE and SD are significant factors mediating MH promotion.

Rest-activity rhythms across the lifespan: cross-sectional findings from the US representative National Health and Nutrition Examination Survey

STUDY OBJECTIVES

Rest-activity rhythms (RAR) may mark development, aging, and physical and mental health. Understanding how they differ between people may inform intervention and health promotion efforts. However, RAR characteristics across the lifespan have not been well-studied. Therefore, we investigated the association between RAR measures with demographic and lifestyle factors in a US nationally representative study.

METHODS

RAR metrics of interdaily stability (IS), intradaily variability (IV), relative amplitude (RA), and mean amplitude and timing of high (M10) and low (L5) activity were derived from 2011 to 2012 and 2013 to 2014 National Health and Nutrition Examination Survey (NHANES) actigraphy data. Population-weighted linear and logistic regression models were fit to examine the associations of age, gender, smoking, alcohol, season, body mass index (BMI), income-to-poverty ratio, and race/ethnicity with RAR. Significance was based on a false-discovery rate-corrected P-value of <0.05.

RESULTS

Among n = 12 526 NHANES participants (3-≥80 years), IS (higher = greater day-to-day regularity) and RA (higher = greater rhythm strength) generally decreased with age and were lower among males, whereas IV (higher = greater rhythm fragmentation) increased with age (p < 0.05). Dynamic changes in RAR trajectories were observed during childhood and adolescence. Income, BMI, smoking, and alcohol use were associated with RAR metrics, as well as season among children and teenagers (p < 0.05). RAR also differed by race/ethnicity (p < 0.05), with trajectories initially diverging in childhood and continuing into adulthood.

CONCLUSIONS

RAR differed by demographic and health-related factors, representing possible windows for public health intervention and sleep health promotion. RAR differences by race/ethnicity begin in childhood, are evident in early adolescence, and persist throughout adulthood.

Exposure to neighborhood poverty from adolescence through emerging adulthood and sleep duration in US adults

Does exposure to neighborhood poverty from adolescence to early adulthood have differential influence on sleep duration across racial/ethnic groups? We used data from the National Longitudinal Study of Adolescent to Adult Health that consisted of 6756 Non-Hispanic (NH) White respondents, 2471 NH Black respondents, and 2000 Hispanic respondents and multinomial logistic models to predict respondent reported sleep duration based on exposure to neighborhood poverty during adolescence and adulthood. Results indicated that neighborhood poverty exposure was related to short sleep duration among NH White respondents only. We discuss these results in relation to coping, resilience, and White psychology.