Discrimination and sleep: a systematic review

• Type of Material: Article
• Authors: Natalie Slopen, University of Maryland College Park; Tene Lewis, Emory University; David R. Williams, Harvard University
• Language: English
• Date: 2016-02-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 Elsevier B.V.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.sleep.2015.01.012
• Title of Journal or Parent Work: Sleep Medicine
• ISSN: 1389-9457
• Volume: 18
• Start Page: 88
• End Page: 95
• Grant/Funding Information: Funding: N Slopen and DR Williams received support from grant RO1 AG038492.; TT Lewis received support from grant K01HL092591.
• Keywords: RACIAL DISPARITIES; Racism; Unfair treatment; CORONARY-HEART-DISEASE; Science & Technology; UNITED-STATES; ETHNIC DISCRIMINATION; Life Sciences & Biomedicine; EVERYDAY DISCRIMINATION; Systematic review; ALL-CAUSE MORTALITY; Clinical Neurology; PERCEIVED DISCRIMINATION; Sleep; AFRICAN-AMERICAN MEN; Discrimination; MIDDLE-AGED ADULTS; Sexism; SELF-RATED HEALTH; Neurosciences & Neurology
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology; Sociology, Ethnic and Racial Studies

Abstract

An increasing body of literature indicates that discrimination has a negative impact on health; poor sleep may be an underlying mechanism. The primary objective of this review was to examine existing studies on the relationship between discrimination and sleep to clarify (a) the potential role of discrimination in shaping population patterns of sleep and sleep disparities, and (b) the research needed to develop interventions at individual and institutional levels. We identified articles from English-language publications in PubMed and EBSCO databases from inception through July 2014. We employed a broad definition of discrimination to include any form of unfair treatment and all self-reported and objectively assessed sleep outcomes, including duration, difficulties, and sleep architecture. Seventeen studies were identified: four prospective, 12 cross-sectional, and one that utilized a daily-diary design. Fifteen of the 17 studies evaluated interpersonal discrimination as the exposure and the majority of studies included self-reported sleep as the outcome. Only four studies incorporated objective sleep assessments. All 17 studies identified at least one association between discrimination and a measure of poorer sleep, although studies with more detailed consideration of either discrimination or sleep architecture revealed some inconsistencies. Taken together, existing studies demonstrate consistent evidence that discrimination is associated with poorer sleep outcomes. This evidence base can be strengthened with additional prospective studies that incorporate objectively measured aspects of sleep. We outline important extensions for this field of inquiry that can inform the development of interventions to improve sleep outcomes, and consequently promote well-being and reduce health inequities across the life course.