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Reducing Health Disparities: The Role of Sleep Deficiency and Sleep Disorders

Executive Summary

Introduction

Eliminating the disproportionate burden of cardiopulmonary and metabolic disease among racial/ethnic groups and by socioeconomic position (SEP) remains a pervasive challenge for the United States (US) health care system. Explanations for health disparities remain incomplete. As diversity of the US population grows, the ability to prevent and eliminate disparities in health risks and disease outcomes will depend on a more complete understanding of racial/ethnic and SEP determinants of health, which are needed to inform intervention strategies.

Decrements in sleep health (e.g. sleep apnea, insufficient sleep time, shift work, insomnia) are wide-spread in the US, and associated with increased cardiovascular risk and disease outcomes, including hypertension, stroke, cardiac arrhythmia, chronic heart failure, obesity, and diabetes; all domains of cardiovascular health disparities. Until recently, racial/ethnic and SEP differences in sleep health, and the possible impact of impaired sleep on cardiovascular health disparities was unrecognized. Multiple factors contribute to sleep health, including lifestyle choices, environmental exposures/demands, psychosocial conditions, physiology and genetics, public policy, and medical conditions/health care. In combination, recent advances point to important scientific questions regarding the prevalence and complex etiology of disparities in sleep health, and the impact of disparities in sleep health on the disproportionate burden of cardiovascular disease in the US population.

Workshop Description

The Division of Lung Diseases (DLD) and the Division for the Application of Research Discoveries (DARD), National Heart, Lung and Blood Institute convened a workshop in September 2011 to discuss and identify exceptional opportunities for research to significantly reduce disparities in cardiovascular morbidity and mortality coupled to sleep health, and to advance our scientific understanding of the role of sleep in realizing optimal health outcomes. Participants included a diverse group of sleep and health disparity researchers with expertise in cardiovascular and metabolic science. An overarching objective of the workshop was to create an opportunity for synergy between two research disciplines that have not traditionally collaborated, but where overlap in scientific opportunity has emerged. The specific charge to the working group included (1) Identify critical gaps in knowledge that need to be overcome in understanding sleep-related health disparities (2) Identify and prioritize exceptional opportunities for research to fundamentally improve our understanding of sleep-related health disparities (3) Describe strategies and prioritize opportunities for translation, dissemination, and application to reduce sleep-related health disparities (4) Assess the concept of "sleep" as a 'fundamental requirement of daily living' and potential implications for future disparities work

The 2-day workshop was organized into five sessions (1) 'Sleep and Health Disparities' (overview by Co-Chairs) (2) 'Disparities in Sleep Health' (3) 'Etiology of Disparities in Sleep Health' (4) ‘Contributions of Sleep to Unexplained Health Disparities’ and (5) 'Diagnosis and Treatment of Sleep Disorders in Minority Populations.' Each session contained three components (a) 20- minute presentations of current evidence and proposed research directions by sleep experts (b) 15-minute commentaries by health disparity experts on the relevance of sleep research in health disparity science and (c) a 60-minute discussion to engage the entire working group to identify priority research recommendations. Prior to the workshop, conference calls were held with individual session groups to stimulate communication and the exchange and coordination of information and ideas, in preparation for the workshop.

Recommendations

  • Advance epidemiology and clinical research to achieve a more complete understanding of disparities in domains of sleep health (i.e. prevalence and severity of sleep apnea, habitual sleep duration, sleep timing and regularity, insomnia complaints) and across population subgroups (i.e. racial/ethnic, socioeconomic position, gender) for which cardiovascular and metabolic health disparities exist.
  • Develop study designs and analytical approaches to explain and predict multilevel and lifecourse determinants of sleep health (i.e. environmental, biological/genetic, psychosocial, societal, political/economic) and to elucidate the sleep-related causes of cardiovascular and metabolic health disparities across the age spectrum.
  • Determine the contribution of sleep impairment (sleep apnea, insufficient sleep duration, irregular sleep schedules, insomnia complaints) to unexplained disparities in cardiovascular and metabolic risk and disease outcomes, by race/ethnicity, socioeconomic position, gender, and age.
  • Develop study designs, data sampling and collection tools, and analytical approaches to optimize our understanding of mediating and moderating factors, and feedback mechanisms coupling sleep to cardiovascular and metabolic health disparities.
  • Advance research to understand barriers (i.e. person, provider, system) to access to care, medical diagnosis, and treatment of sleep disorders in diverse population groups. Develop and test multi-level interventions (including sleep health education in diverse communities) to reduce disparities in sleep health that will impact our ability to improve disparities in cardiovascular and metabolic risk/disease.
  • Create opportunities to integrate sleep and health disparity science by strategically utilizing resources (i.e. existing or anticipated cohorts), exchanging scientific data and ideas (i.e. cross-over into scientific meetings), and develop multi-disciplinary investigator-initiated grant applications.
  • Enhance the diversity and foster career development of young investigators involved in sleep and health disparities science.

Workshop Roster


Co-Chairs

  • Ana Diez-Roux, MD, PhD, MPH, University of Michigan
  • Eve Van Cauter, PhD, University of Chicago

Participants

  • Gary G. Bennett, PhD, Duke University
  • Carla Boutin-Foster, MD, Cornell University
  • Joseph Buckhalt, PhD, Auburn University
  • Orfeu M. Buxton, PhD, Harvard Medical School, Brigham and Women's Hospital
  • Mercedes R. Carnethon, PhD, FAHA, Northwestern University
  • Lisa A. Cooper, MD, MPH, Johns Hopkins University
  • Tiffany Gary-Webb, PhD, Columbia University
  • Maria Glymour, Sc.D., Harvard University
  • Michael Grandner, PhD, University of Pennsylvania
  • Lauren Hale, PhD, SUNY Stony Brook University
  • Girardin Jean-Louis, PhD, SUNY Downstate Medical Center
  • Kristen Knutson, PhD, University of Chicago
  • Nancy Kressin, PhD, Boston University
  • Kenneth L. Lichstein, PhD, University of Alabama
  • Karen A. Matthews, PhD, University of Pittsburgh
  • Carlos F. Mendes de Leon, PhD, University of Michigan
  • Sanjay R. Patel, MD, MS, Harvard Medical School
  • Naresh M. Punjabi, MD, PhD, Johns Hopkins University
  • David Takeuchi, PhD, University of Washington

NHLBI

  • Aaron D. Laposky, PhD, Program Director, Sleep and Neurobiology, Division of Lung Diseases
  • Michael Twery, PhD, Director, National Center on Sleep Disorders Research, Division of Lung Diseases
  • Denise Simons-Morton, MD, PhD, MPH, Director, Division for the Application of Research Discoveries
  • James P. Kiley, PhD, Director, Division of Lung Diseases

Last Updated: December 2011

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