Elsevier

Sleep Medicine Reviews

Volume 17, Issue 4, August 2013, Pages 255-262
Sleep Medicine Reviews

Clinical review
Sleep in America: Role of racial/ethnic differences

https://doi.org/10.1016/j.smrv.2012.07.002Get rights and content

Summary

Sleep duration in America has gradually declined over the last four decades and appears to have reached a plateau for the last six years, with recent studies reporting that the population’s current average sleep duration is approximately 6 h. In this paper, we examine epidemiologic and community-based data on sleep complaints reported by American adults, specifically addressing the role of race/ethnicity in the subjective report of sleep problems. Subjective and objective findings indicate that black (throughout the text, we use the term black in lieu of African American for there are instances where we refer to individuals with self-ascribed race/ethnicity as black, African American, African, or Caribbean American; the term white is used to denote individuals of European descent). Americans have higher rates of long (≥9 h) and short (≤5 h) sleep than their white counterparts, and this may mediate a higher risk of cardiovascular disease, obesity and diabetes among blacks. In addition, studies show mixed results on sleep complaints among blacks compared to those among other ethnicities. This paper explores factors that may contribute to racial/ethnic differences in sleep including intra-ethnic variation, cultural biases, genetics and psychosocial factors.

Section snippets

Decline in sleep duration in America

Epidemiologic and community-based studies have shown that nightly sleep duration in America declined from 1960 to 2000 and seems to have a reached a plateau at approximately 6–6.5 h for the last six years (Table 1). In 1960, epidemiologic data from the American Cancer Society showed that the average sleep duration nationwide was 8.5 h.1 The 1982 cancer prevention study II found that among 1.1 million Americans, the modal sleep duration was 8 h.2 Analysis of the 1982–1984 national health and

Sleep duration: evidence supporting racial/ethnic differences

Concomitant with data showing sleep decline in America is a recent wave of findings showing that blacks have the highest prevalence of long (≥9 h) and short sleep (≤5 h) in America.*5, *19, *20 In light of such findings, this paper focuses on comparisons of sleep between blacks and other ethnicities, primarily whites, as these two groups have been extensively studied. The 2010 sleep in America poll showed that blacks reported the least amount of sleep on weekdays, averaging 38 min less sleep

Consequences of sleep problems: evidence supporting racial/ethnic differences

Residual daytime sleepiness, a direct result of sleep loss, has become a serious problem in the United States, negatively affecting cognitive performance. Residual daytime sleepiness is linked to decreased psychomotor and cognitive speed, attention/concentration, memory, and ability to drive,18 and increased risk for mortality in adults >65 y when combined with sleep disordered breathing.37 This decline in cognitive function occurs in a sleep dose-dependent manner.38, 39 Researchers found speed

Sleep complaints: evidence supporting racial/ethnic differences

There are no nationwide epidemiological trend studies on sleep complaints commonly included in insomnia definitions: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA). Therefore, it is unclear whether sleep complaints reported by Americans have increased or decreased over the last four decades. It is likely that sleep complaints would increase, if in fact sleep durations have declined substantially.

Studies examining racial/ethnic

Sleep complaints: evidence supporting intra-ethnic differences

There are several studies showing intra-ethnic differences in sleep among Hispanics.86 Currently two large-scale National Institute of Health (NIH)-sponsored studies are being done exploring sleep disorders, including sleep apnea, and sleep risk within Hispanic populations with different countries of origin. Few such intra-ethnic studies have been done among blacks in the United States.

Our study of older Brooklyn residents has allowed the recognition of intra-ethnic heterogeneity in sleep

The role of repressive coping and response bias in underreporting of sleep complaints by black Americans

While there are no studies to date that examine the prevalence of underreporting of sleep complaints among black Americans over time, studies on perception of other health parameters suggest that blacks tended to report fewer self-perceived health problems than did whites. Of interest are epidemiologic and vital statistics data demonstrating that blacks have worse health outcomes than whites.59, 88, 89 The possibility of a bias in reporting among blacks may extend to subjective sleep data as

Conclusion

The preponderance of evidence suggests that sleep duration in America has been declining gradually, at least up to the 2000s. Blacks seem to be characterized by a higher prevalence of long and short sleep compared with other ethnicities. Although further research is warranted, current studies show that poor sleep may mediate increased risk of type-2 diabetes, CVD, and obesity among blacks (Fig. 1). Studies point to differences in anatomy, sleep architecture and genetics as a biological basis

Disclosure

No potential conflicts of interest relevant to this article were reported.

Acknowledgments

This research was supported by funding from the NIH (R01MD004113 and R01HL095799). We thank Dr. Carol Magai, the Director of the Intercultural Institute at Long Island University, for providing access to the Brooklyn sleep data reviewed in this paper.

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