Associations of Self-Reported Sleep Quality with Demographic and Other Characteristics in Older Korean Immigrants

Sleep Quality of Persons with Dementia and Family Caregivers in Korean Americans: Wearable Technology to Study the Dyadic Association

BACKGROUND

Sleep disturbances, such as difficulty in falling asleep and multiple awakenings at night, are prevalent among persons with Alzheimer's disease and related dementias (hereafter dementia), resulting in advanced cognitive impairment and increased behavioral problems. Additionally, family caregivers (eg, spouses or offspring) suffer from reduced sleep quality as a result of sleep disturbances in the persons with dementia (PWDs) they care for. Relatively little is known about the interaction of sleep parameters in dyads (PWD-caregiver) as paired units among understudied immigrant minorities, particularly Korean Americans.

OBJECTIVES

To describe dyads' sleep parameters (ie, total/deep/rapid eye movement/light sleep, awake duration, latency duration, sleep efficiency) using wearable technology (smart-rings) and sleep diaries, and to identify interrelationships among sleep parameters between PWD and caregivers.

METHODS

This 4-week observational study used smart-ring monitoring, a sleep survey, and self-reported sleep diaries to explore sleep associations of Korean American dyads recruited from the community. Pearson correlations were performed.

RESULTS

A total of 11 dyads participated in the study. The mean age of PWD was 82.7 years (standard deviation (SD) = 2.3); of caregivers 69.1 years (SD = 10.2). Nine PWD (81.8%) were male, all caregivers (100%) were female, and 4 dyads (36.4%) slept in the same bed. Sleep parameters of PWD were significantly correlated with those of caregivers.

CONCLUSION

Our findings demonstrate that PWD's sleep parameters (eg, deep sleep) were significantly correlated with those of caregivers' parameters. This study shows the feasibility of using wearable device to measure dyadic sleep quality for both PWD and their caregivers, particularly within immigrant populations.

Correlates and Health Issues among Older Korean Immigrants Living Alone in the United States: A Scoping Review

Older Korean immigrants are one of the most understudied and marginalized Asian ethnic groups in the United States, despite their rapid population growth. Many older Korean immigrants encounter distinct challenges in assimilating into their new country as first-generation immigrants, including cultural conflict, language barriers, low economic status, and a lack of social support. These issues may be compounded for those who live alone, which is considered a negative factor in their mental and physical health. However, little is known about the correlates and health issues of older Korean immigrants living alone. This study's objective was to explore correlates and health issues among older Korean immigrants living alone. Based on established scoping review methodology five databases, CINAHL, PubMed, MEDLINE, SocINDEX, and Health Source Nursing/Academic Edition, were used to find relevant studies. Twelve articles were reviewed, and four major themes were identified as correlates and health issues among older Korean immigrants living alone in the United States: depression, changed family relationships, social interactions, and factors on general health and well-being. The findings have significant implications for healthcare professionals for understanding the unique culture, situation, and physical and psychosocial vulnerability of older Korean immigrants living alone.

Gender-specific link between sleep quality and body composition components: a cross-sectional study on the elderly

Sleep duration has been associated with overweight/obesity. Since sleep quality and body composition alter during aging, we conducted this study to determine if sleep quality is linked to body composition components in elderly people. This is a cross-sectional study conducted on 305 Iranian community-dwelling elderly aged ≥ 65 years. Sleep quality and body composition components were evaluated using Pittsburgh sleep quality index and bioelectric impedance analysis, respectively. The association of sleep quality and body composition components was examined using linear regression analysis. The prevalence of poor sleep quality and overweight/obesity was 48.9% and 54.4% in men and 77.0% and 79.3% in women, respectively. Women had significantly higher scores in most PSQI items than men, indicating their worse sleep quality compared to men. Women also had significantly higher body mass index (BMI), body fat percentage, and visceral adipose tissue and lower skeletal muscle and fat-free mass percentages than men. In the adjusted regression model, men showed positive associations between the third tertile of poor sleep quality and BMI (B = 1.35; 95% CI 0.08-2.61) and waist circumference (B = 4.14; 95% CI 0.39-7.89), but they did not demonstrate an association between sleep quality and body composition components. In the adjusted regression model for women, there were positive associations for BMI (B = 1.21; 95% CI 0.34-2.07), waist circumference (B = 2.95; 95% CI 0.99-4.91), body fat percentage (B = 2.75; 95% CI 1.06-4.45), and visceral adipose tissue (B = 7.80; 95% CI 1.73-13.87); also there were negative associations for skeletal muscle (B =  - 1.40; 95% CI - 2.39 - - 0.41) and fat-free mass (B =  - 2.76; 95% CI - 4.46 - -1.07) percentages. Except for waist circumference, other variables differed between men and women (P < 0.001). Weight management, prevention of muscle wasting, and improvement of sleep quality should be considered in a consortium when designing healthcare strategies for the elderly.

Sleep disturbances and interrelationship between persons with dementia and family caregivers: The lived experiences of Korean American Dyads

BACKGROUND

Little research has investigated sleep quality in dyadic interrelationships between persons with dementia (PWD) and family caregivers, particularly among immigrant ethnic minorities, such as Korean Americans.

PURPOSE

The study aimed to describe lived experiences of sleep disturbances and sleep interrelationships between Korean American PWD and their family caregivers.

METHODS

A descriptive qualitative design used semi-structured interviews with cohabitating PWD-caregiver dyads.

RESULTS

Eleven Korean American dyads participated (PWD mean age: 82.7, SD=2.3; caregivers mean age: 69.1, SD=10.2). Major themes included (1) linked sleep disturbances between PWD and caregivers, (2) interrelationship in dyads, (3) language challenges within and outside the dyads, and (4) strategies that improve sleep quality for dyads.

CONCLUSION

Findings demonstrated bidirectional influences in dyadic sleep disturbances, where caregiving reciprocally impacted PWD sleep as part of an interactional unit. Communication barriers and limited community resources posed challenges for these dyads. Future sleep interventions should consider culturally competent, dyadic approaches.

A systematic review of acculturation and sleep health among adult immigrants in the United States

The United States (US) has more immigrants than any other country in the world, with an estimated 44 million non-US-born individuals residing in the country as of 2018. Previous studies have linked US acculturation to both positive and negative health outcomes, including sleep. However, the relationship between US acculturation and sleep health is not well understood. This systematic review aims to identify and synthesize scientific studies on acculturation and sleep health among adult immigrants in the US. A systematic search of the literature was performed in PubMed, Ovid MEDLINE, and Web of Science in 2021 and 2022 with no date limiters. Quantitative studies published anytime in a peer-reviewed journal in English among an adult immigrant population with an explicit measure of acculturation and a sleep health dimension, sleep disorder, or daytime sleepiness measure were considered for inclusion. The initial literature search yielded 804 articles for review; after removing duplicates, applying inclusion and exclusion criteria, and searching reference lists, 38 total articles were included. We found consistent evidence that acculturative stress was associated with worse sleep quality/continuity, daytime sleepiness, and sleep disorders. However, we discovered limited consensus on the association of acculturation scales and acculturation proxy measures with sleep. Our review demonstrated that compared to US-born adult populations, there is a high prevalence of adverse sleep health among immigrant populations, and acculturation likely plays an important role in shaping this disparity, particularly through acculturative stress.

Sleep disparities in Asian Americans: a comprehensive review

STUDY OBJECTIVES

This review summarizes race-based sleep health disparities between Asian Americans and other American racial groups and compares sleep outcomes between Asian American subgroups disaggregated by ethnicity and ancestral national origin. The study identifies gaps in the existing literature, analyzes barriers to studying Asian American sleep, and recommends topics for future research.

METHODS

A PubMed review of research on adult Asian American sleep was conducted. The articles included utilized actigraphy, polysomnography, and questionnaires to gather sleep health metrics. Information from these articles included data on sleep duration, sleep quality, sleep disturbances, and sleep disorders.

RESULTS

Most aggregated studies find Asian American adults experiencing lower sleep duration and poorer sleep quality compared to non-Hispanic White Americans and comparable or slightly higher sleep duration compared to Black Americans. Within Asian Americans, first-generation immigrants report better sleep quality than subsequent generations. East Asian Americans may experience better sleep outcomes compared to Southeast Asian Americans. Obstructive sleep apnea is critically underreported in South Asian Americans.

CONCLUSIONS

Significantly more research is required in Asian American sleep disparities, specifically in South and Southeast Asian Americans. Sleep disparities between Asian Americans and other racial groups are impacted by perceived discrimination, poor mental health, and cultural attitudes toward sleep. The observed within-group disparities of Asian American sleep may be attributed to socioeconomic status and generational status/acculturation. Existing barriers to research include the model minority myth and lack of disaggregated racial sleep data.

CITATION

Nandagiri V, Vannemreddy S, Spector A. Sleep disparities in Asian Americans: a comprehensive review. J Clin Sleep Med. 2023;19(2):393-402.

Sleep Health, Acculturation, and Acculturative Stress in Immigrants in the United States: A Scoping Review

INTRODUCTION

Poor sleep health has been widely associated with chronic illnesses, and immigrant populations in the United States do not experience optimal sleep, putting them at increased risk of such illnesses. The purpose of this scoping review was to synthesize published literature on the influence of acculturation and acculturative stress on the sleep health of immigrant populations in the United States.

METHOD

This scoping review was guided by Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline, and 16 research articles were included in its synthesis of results.

RESULTS

Findings indicated that immigrants in the United States have poor sleep health and that acculturation and acculturative stress may be major influencing factors. In addition, demographic and socio-contextual factors such as gender, economic status, education, and employment characteristics influenced immigrants' sleep. Race and ethnicity were additional factors influencing sleep, but the limited number of studies in this area precludes determination of which groups are most affected. Chronic stress, depressive symptoms, and language influenced immigrants' sleep health, but mixed results were observed for generational status.

DISCUSSION

Future sleep studies should include vulnerable and understudied immigrant groups and consider all socio-contextual and psychological factors potentially affecting sleep health. In health settings serving immigrant groups, nurses should emphasize screening for these factors. Also, comparative studies are needed to identify specific factors that may affect sleep health in particular immigrant ethnic groups.