DST Debate Highlights Growing Racial Inequalities in Sleep Health


As the United States set back an hour this month to observe the end of summer timemany people slept a little more than usual, but some not as much as others.

Growing evidence shows that sleep deprivation and sleep disorders, such as obstructive sleep apnea, remain more prevalent in Black, Asian, and Hispanic or Latino communities, and these inequalities may have consequences long-term damage to physical health, even increasing the risk of certain chronic diseases.

Meanwhile, daylight saving time itself – enacted in the United States to reduce electricity consumption by extending daylight hours – has long been controversial in the United States.

The American Academy of Sleep Medicine, Society for Sleep Research and other medical groups have advocated for an end to the practice, calling for the adoption of a permanent standard time that would not involve advancing every spring and to recede each fall.

“DST is associated with increased risks of sleep loss, circadian misalignment and adverse health consequences,” said Dr. Beth Malow, professor of neurology and pediatrics and director of the division of sleep from Vanderbilt University Medical Center in Nashville. said in a statement this month. She authored an article published in September in the journal Sleep detailing the potential health benefits of adopting a permanent time standard.

In March, the U.S. Senate unanimously passed the Sunscreen Act, which would make daylight saving time permanent across the country — meaning there would be no going back to “daylight saving time.” standard” from early November to mid-March – but the legislation is expected to pass the House and earn President Joe Biden’s signature before taking effect in November 2023.

Now, some sleep researchers are concerned about the potential effects that continuing to change the standard time twice a year may have on sleep health inequities.

“Poor quality sleep is associated with a host of health problems, including obesity, hypertension, type 2 diabetes, cardiovascular disease, and certain cancers, including breast and colon. Many of these health conditions are more prevalent in the black population,” said Chandra Jackson, a researcher and epidemiologist at the National Institute of Environmental Health Sciences who has studied racial and ethnic disparities in sleep.

“Experimental and observational studies have linked sleep to these health outcomes. Therefore, sleep could be an important contributor,” she said. “Fortunately, sleep health is largely modifiable. »

When it comes to the observed inequalities in sleep health, it’s not that white adults don’t also suffer from sleep deprivation and its health consequences – but people of color seem to experience them more. disproportionately, and this is believed to be largely due to social systems in the United States.

Sleep allows the body to restore itself at the cellular level. During quality sleep, your heart rate, blood pressure, and breathing can go up and down, which can be important for cardiovascular health, and your body releases hormones that help repair cells and control its energy intake. energy, according to the National Institutes of Health. These hormonal changes can also influence your weight.

A study published in October in the journal PLOS Medicine suggests that people aged 50 and over who sleep five hours or less at night have a higher risk of multiple chronic diseases as they age compared to their peers who sleep more. long time.

Separate research, also published in October in the Journal of the American Heart Association, shows that heart health guidelines are better at predicting a person’s risk of heart disease if they include sleep — and don’t focus solely on diet and exercise.

Certain physiological processes – such as immune function, cardiovascular health and memory formation – require a certain amount of sleep. So without enough sleep, the body and brain may not function optimally, said Dr César Caraballo-Cordovez, a postdoctoral associate at Yale’s Center for Outcomes Research and Evaluation, who has studied racial and ethnic disparities in sleep duration.

“Short sleep duration has been associated with a higher risk of adverse medical events and conditions, including diabetes, obesity, hypertension, heart disease, impaired cognitive function, and death,” wrote Caraballo-Cordovez in an email, adding that the consensus is that most adults need at least seven hours of sleep a day.

Yet racial and ethnic disparities in sleep duration appear to be widening in the United States, according to recent research by Caraballo-Cordovez, Jackson and their colleagues. Their study, published in April in the medical journal JAMA Open Network, found that among more than 400,000 adults in the United States, between 2004 and 2018, the prevalence of short and long sleep duration was consistently higher among those who were black and Hispanic or Latino. Short sleep lasts less than seven hours a day and long sleep exceeds nine hours.

Although there was a significant increase in the prevalence of sleep deprivation in all groups over the study period, the prevalence of short sleep increased by 6.39 and 6.61 percentage points among black and Hispanic or Latino adults, respectively, compared to 3.22 percentage points among whites.

Several social and environmental factors that can interfere with sleep are more common among blacks and Hispanics or Latinos in the United States, Caraballo-Cordovez said.

“Among these are housing conditions, noise pollution, light pollution, air pollution, stress from different sources – including perceived racial discrimination – and jobs or working conditions,” he said, adding that the convergence of all these factors may explain why getting the recommended amount of sleep “may be less common among black adults than among white adults.”

Caraballo-Cordovez and Jackson both point out that the causes of racial inequality in sleep warrant more research.

Many social and environmental determinants of health – including living conditions or work schedules that do not promote sleep – may emerge, at least in part, from historical and persistent forms of structural racism, which Jackson sees as the “the totality of ways in which societies promote racial discrimination through housing, education, employment, wages, benefits, credit, media, health care, and criminal justice systems that mutually reinforce each other.

Jackson added that she often reflects on how the shooting death of Breonna Taylor in Louisville in March 2020 and the shooting of George Floyd’s 4-year-old grandniece in Houston on New Year’s Day happened. while they sleep — and how systems of structural racism in the United States can cultivate conditions that make such incidents more likely to occur in black communities. “That would require research,” she said.

Examples of structural racism and how they can impact health include the history of discriminatory mortgages and appraisals in the United States, which affect the conditions in which people of color can live; how predominantly white school districts tend to get more funding than districts serving people of color, impacting the quality of education some people of color can receive; and even how hair discrimination may contribute to some black women using potentially harmful chemical hair products, as policies might not allow specific hairstyles at school or work.

“These policies and practices can produce disparities due to the misallocation of healthy or harmful resources among racial groups and can, in turn, reinforce discriminatory beliefs,” Jackson said. “In other words, discriminatory policies and practices across all sectors of society are believed to create the physical and social conditions that make it harder for Black families to get optimal sleep and grow up healthy. Fortunately, these policies and practices are also changeable.

While more research into the causes of sleep disparities is needed, she said, essentially anything that produces physical and psychological stress is a threat to sleep health, and these stressors tend to be more prevalent in black communities.

In the U.S. Department of Health and Human Services Healthy People 2030 Plan for the Nation, improving health by helping people get enough sleep has been listed as a goal, with goals such as increasing proportion of adults with sleep apnea symptoms assessed by a health care provider and the increase in the proportion of schools starting later in the morning. Improving sleep health has been a national goal in the federal government’s last two Healthy People programs, noted Caraballo-Cordovez, who is not involved in the programs.

But he added that “the impact of strategies focused on improving sleep knowledge and habits – while important and necessary – can be limited if they do not address the persistent barriers that disproportionately prevent blacks to achieve and maintain a healthy life.

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