Goal 4: Advance the Scientific Understanding of Sleep and Circadian Contributions to Health Disparities in Diverse Populations, and Their Different Impacts on the Public Safety of These Populations

Sleep health disparities (SHDs) are differences in one or more dimensions of sleep health (duration, efficiency, timing, regularity, alertness, and quality) —on a consistent basis— that adversely affect designated disadvantaged populations. The designated health disparity populations include American Indians/Alaska Natives, Asian Americans, Blacks/African Americans, Hispanics/Latinos, Native Hawaiians and other Pacific Islanders, sexual and gender minorities, the socioeconomically disadvantaged; and those living in underserved rural areas. Pronounced SHDs can be found among these populations in the U.S. The incidence and prevalence of sleep deficiencies at a population level are influenced by many of the same determinants that influence other health outcomes with known disparities. Understanding the factors that contribute to these disparities in sleep and circadian rhythms-related disease risk will inform improved approaches for personalized medicine. Thus, a nuanced integration of health disparity causal pathways and sleep and circadian-related mechanisms, tailored for the specific population(s) and sensitive to the sociocultural context(s), is needed to understand and address SHDs.

Strategies to address SHDs were identified by the research community and described in detail in an article, "A workshop report on the causes and consequences of sleep health disparities." Those strategies include: a) develop and promote integrative research on SHDs, b) investigate the causes and health consequences of SHDs, and c) develop interventions to address SHDs.

This research would:

  • Improve sleep health by targeting populations that experience health disparities.
  • Enable more patient-centered approaches to prevent, diagnose and treat sleep and circadian rhythm disorders.
  • Advance effective public health and safety policies that address SHDs.

High-Priority Research Areas

Education and Awareness

  • Develop education-based studies to increase societal awareness of the importance of consistent sleep and circadian rhythms, as well as adequate nutrition and physical activity, to promote optimal health among underserved U.S. populations.
  • Develop studies to investigate how increased social awareness of the effects of short- and long-term chronic drinking on sleep quality impact behavior.
  • Improve understanding of sex and gender differences in sleep quantity and quality in relation to demographic and social determinants of health.
  • Understand the relative contribution of environment/geolocation, racial discrimination, and adverse childhood experiences on sleep and sleep disorders across race/ethnicity.
  • Enable data-driven health policies aimed at promoting consistent sleep and circadian rhythms and management of sleep and circadian disorders in populations burdened by health disparities.
  • Enable community-based research to facilitate comparative-effectiveness, dissemination, and implementation research in sleep and circadian disorders.
  • Develop studies to investigate how increased awareness of sleep and circadian rhythms disorders play a role in the health and well-being of underserved populations, including shift workers and patients with sleep and circadian rhythm disorders.
  • Develop multilevel strategies to disseminate and implement guideline-based and high-quality care for sleep and circadian rhythm disorders in populations with existing health disparities.

Native american dad walking in the countryside with his two children

Improving Treatments for Population Experiencing Disparities

  • Develop multilevel interventions that incorporate social and environmental determinants of health to address disparities in sleep and circadian rhythms health care.
  • Leverage information technology and data science to promote health equity in prevention, identification, and treatment of populations experiencing health disparities.
  • Develop interventions for healthcare settings that serve socioeconomically disadvantaged and rural populations.
  • Develop and test endotyping, phenotyping and diagnosis protocols to advance treatment of gestational OSA in underrepresented women.
  • Validate commonly used sleep metrics in populations experiencing disparities, and/or develop new sleep metrics that will be valid in these populations.
  • Develop transdisciplinary approaches, including mobile health technologies, to address sleep health disparities in sleep disorders by engaging not-well-reached (priority) populations, enabling interventions, and developing outcomes assessments.

same sex couple smiling and laughing

Population and Environmental Analyses

  • Study the characteristics of social and physical environments in schools, colleges, healthcare facilities, and workplaces that promote good sleep and aligned circadian rhythms, noting the effects on the health and health-related quality of life, healthy development and behaviors and mental health in under-served populations across all life stages.
  • Identify and measure qualitative and quantitative measures that reveal barriers to and facilitators for promoting equity in healthcare delivery for sleep and circadian disorders.
  • Investigate racism, sexism, and other forms of discrimination as a major contributor to cumulative chronic stress and a driver of disparities in sleep and circadian disorders.
  • Understand the relative contribution of environment/geolocation, racial discrimination, and adverse childhood experiences on sleep and sleep disorders across race/ethnicity.
  • Gain understanding of geographic variability in healthcare delivery to patients with sleep and circadian disorders, as well as determine how such variability influences health and well-being.
  • Develop and test “real-world” interventions through novel, system-level redesigns aimed at promoting improved sleep and circadian rhythms in shift workers, and study their effects on health, well-being, and patient and public safety, especially in populations that experience SHDs.
  • Integrate sleep and circadian research into big-data analytics and leverage social media metrics coming from beyond the biomedical realm to present research such that findings might be understood and adopted by those with SHDs.
  • Explore the effect of sleep and circadian disorders in the workplace with respect to absenteeism, presenteeism, costs to employers, and workplace safety.
  • Develop novel approaches for multi-modal detection of sleepiness and fatigue (including biomarkers) in transportation and related industries.
  • Develop and implement mechanisms for preventing fatigue and sleepiness related accidents in homes, transportation, health care, and other industries.
  • Study the multifactorial relationships between social, environmental, and policy level factors (e.g., discrimination, noise) and sleep and circadian health among U.S. underserved populations.

Mid adult couple expecting a baby while husband caresses the belly of his pregnant african woman

Aligning with an essential focus of NIH, the health of women is also a priority in sleep and circadian research. Sex differences in sleep emerge at a very early age and as time passes, may be affected by variations in reproductive hormones, stress, depression, aging, and life/role transitions, including changes in sleep related to menstruation, pregnancy, post-childbirth, and menopause. Women report poorer sleep quality and have higher risk for insomnia than do men and special considerations that acknowledge sex as a biological variable should be made when considering treatment.