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Omenka O, Briggs A, Nunes J, Seixas A, Williams N, Jean-Louis G. Ethical and Policy Implications of Racial and Ethnic Healthcare Disparities in Sleep Health. J Racial Ethn Health Disparities 2024; 11:2509-2515. [PMID: 37488315 DOI: 10.1007/s40615-023-01716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
Despite efforts in recent years, including in policy and research, to address health disparities in the United States, many of those disparities continue to fester in marginalized racial/ethnic populations. Understanding sleep health disparities is critical in understanding the health and wellness of these groups. Using obstructive sleep apnea (OSA) in Black populations as a focus, this paper presents the role of race and ethnicity in the clinical understanding of sleep health-related issues by medical practitioners and the implications of the lack of clear policies or best practices to guide medical practitioners' attempts to meet sleep-related needs of marginalized racial/ethnic populations. Furthermore, the knowledge gap may be further complicated by the poor understanding and integration of existing evidence with the many, complex, sleep-associated co-morbidities. Policymaking in this area ought to be based on the ethical implications of disparate sleep-related health outcomes by race and ethnicity. So, we conclude by offering recommendations for developing ethically sound policies for addressing sleep problems in marginalized racial and ethnic populations.
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Affiliation(s)
- Ogbonnaya Omenka
- Department of Health Sciences, Butler University College of Pharmacy and Health Sciences, 4600 Sunset Avenue, Indianapolis, IN, USA.
| | - Anthony Briggs
- Department of Psychiatry, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Joao Nunes
- Department of Behavioral Sciences, City College of New York, New York, NY, USA
| | - Azizi Seixas
- Media and Innovation Lab, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Nastasha Williams
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Girardin Jean-Louis
- Department of Psychiatry, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
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McCurry KL, Toda-Thorne K, Taxali A, Angstadt M, Hardi FA, Heitzeg MM, Sripada C. Data-driven, generalizable prediction of adolescent sleep disturbances in the multisite Adolescent Brain Cognitive Development Study. Sleep 2024; 47:zsae048. [PMID: 38366843 PMCID: PMC11168765 DOI: 10.1093/sleep/zsae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/21/2024] [Indexed: 02/18/2024] Open
Abstract
STUDY OBJECTIVES Sleep disturbances are common in adolescence and associated with a host of negative outcomes. Here, we assess associations between multifaceted sleep disturbances and a broad set of psychological, cognitive, and demographic variables using a data-driven approach, canonical correlation analysis (CCA). METHODS Baseline data from 9093 participants from the Adolescent Brain Cognitive Development (ABCD) Study were examined using CCA, a multivariate statistical approach that identifies many-to-many associations between two sets of variables by finding combinations for each set of variables that maximize their correlation. We combined CCA with leave-one-site-out cross-validation across ABCD sites to examine the robustness of results and generalizability to new participants. The statistical significance of canonical correlations was determined by non-parametric permutation tests that accounted for twin, family, and site structure. To assess the stability of the associations identified at baseline, CCA was repeated using 2-year follow-up data from 4247 ABCD Study participants. RESULTS Two significant sets of associations were identified: (1) difficulty initiating and maintaining sleep and excessive daytime somnolence were strongly linked to nearly all domains of psychopathology (r2 = 0.36, p < .0001); (2) sleep breathing disorders were linked to BMI and African American/black race (r2 = 0.08, p < .0001). These associations generalized to unseen participants at all 22 ABCD sites and were replicated using 2-year follow-up data. CONCLUSIONS These findings underscore interwoven links between sleep disturbances in early adolescence and psychological, social, and demographic factors.
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Affiliation(s)
| | | | - Aman Taxali
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Mike Angstadt
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Felicia A Hardi
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Mary M Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Chandra Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Solano-Pérez E, Coso C, Romero-Peralta S, Castillo-García M, López-Monzoni S, Ortigado A, Mediano O. New Approaches to the Management of Cardiovascular Risk Associated with Sleep Respiratory Disorders in Pediatric Patients. Biomedicines 2024; 12:411. [PMID: 38398013 PMCID: PMC10887096 DOI: 10.3390/biomedicines12020411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Exposure to risk factors in youth can exacerbate the development of future cardiovascular disease (CVD). Obstructive sleep apnea (OSA), characterized by repetitive episodes of airway obstructions, could trigger said CVD acting as a modifiable risk factor. Measurements from echocardiography have shown impairments in the anatomy and function of the heart related to the severity of OSA. Therefore, the aim of this review was to propose a new clinical approach to the management of cardiovascular risk (CVR) in children based on treating OSA. The review includes studies assessing echocardiographic parameters for cardiac function and structure in pediatric OSA diagnosed using the apnea-hypopnea index (AHI) ≥ 1/h using polysomnography (PSG) and conducted within a year. Based on the reviewed evidence, in addition to PSG, echocardiography should be considered in OSA children in order to indicate the need for treatment and to reduce their future CVR. A follow-up echocardiography after treatment could be performed if impairments in the anatomy and function were found. Prioritizing parameters intimately connected to comorbidity could propel more effective patient-centered care. In conclusion, a reevaluation of pediatric OSA strategies should be considered, emphasizing comorbidity-related parameters in the cardiovascular field. Further studies are needed to assess this approach, potentially leading to enhanced protocols for more effective pediatric OSA treatment and CVR prevention.
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Affiliation(s)
- Esther Solano-Pérez
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
| | - Carlota Coso
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
| | - Sofía Romero-Peralta
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
- Sleep Research Institute, 28036 Madrid, Spain
| | - María Castillo-García
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
- Sleep Research Institute, 28036 Madrid, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain;
| | - Sonia López-Monzoni
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
| | - Alfonso Ortigado
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain;
- Paediatric Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
| | - Olga Mediano
- Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (E.S.-P.); (C.C.); (S.R.-P.); (M.C.-G.); (S.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), 45071 Toledo, Spain
- Medicine Department, Universidad de Alcalá, 28805 Madrid, Spain;
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Duraccio K, Erickson L, Jones MS, Pierce H. Early adverse childhood experiences and adolescent sleep outcomes. CHILD ABUSE & NEGLECT 2024; 147:106593. [PMID: 38061279 DOI: 10.1016/j.chiabu.2023.106593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Sleep is critical for physical, mental, and emotional health. This may be particularly true for adolescents experiencing rapid physiological changes. Relatively little is known about how adverse childhood experiences (ACEs) are implicated in adolescent experiences with sleep. OBJECTIVE We use data (from the Future of Families and Child Wellbeing Study (FFCWS, n = 3444) to assess the relationship between early ACE exposure (by age 5) and various adolescent sleep outcomes. We anticipate that early ACEs will be associated with poor adolescent sleep outcomes. METHODS FFCWS data includes survey responses from parents and/or primary caregivers and children at birth and approximately one, three, five, nine, and 15 years later. The FFCWS oversampled unmarried parents with low educational attainment, income, and from marginalized racial-ethnic groups. Models of sleep outcomes included ordinary least squares, Poisson, negative binomial, logistic, and order logistic regression, as appropriate. RESULTS Despite a high number of ACEs, adolescent hours of sleep were consistent with published recommendations. Other measures of sleep indicated adolescents in the sample experience worse sleep on most other measures. ACE exposure was associated with difficulty falling asleep and staying asleep. More ACEs was also related with problematic sleep environments (i.e., place slept) and increased snoring. There was some evidence that ACEs were related to less sleep on weekends and increased social jet lag (different patterns of sleep between weekdays and weekends). CONCLUSIONS Our findings suggest that ACEs could be important diagnostic data for clinicians in primary care and behavioral sleep medicine practice.
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Hazkani I, Billings KR, Thompson DM. Adenotonsillectomy or Watchful Waiting for Pediatric Sleep-Disordered Breathing. JAMA 2023; 330:2057-2058. [PMID: 38051336 DOI: 10.1001/jama.2023.22373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Inbal Hazkani
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Kathleen R Billings
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Dana M Thompson
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Fayson SD, Leis AM, Garetz SL, Freed GL, Kirkham EM. Racial Disparity in Residual Sleep Apnea After Adenotonsillectomy. Otolaryngol Head Neck Surg 2023; 169:1309-1318. [PMID: 37210616 DOI: 10.1002/ohn.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/05/2023] [Accepted: 04/24/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Black children have a higher risk of residual obstructive sleep apnea after adenotonsillectomy than non-Black children. We analyzed Childhood Adenotonsillectomy Trial data to better understand this disparity. We hypothesized that (1) child-level factors, such as asthma, smoke exposure, obesity, sleep duration, and (2) socioeconomic factors, such as maternal education, maternal health, and neighborhood disadvantage, may confound, modify, or mediate the association between Black race and residual obstructive sleep apnea after adenotonsillectomy. STUDY DESIGN Secondary analysis of a randomized controlled trial. SETTING Seven tertiary care centers. METHODS We included two hundred and twenty-four 5-to-9-year-olds with mild-to-moderate obstructive sleep apnea who underwent adenotonsillectomy. The outcome was residual obstructive sleep apnea 6 months after surgery. Data were analyzed with logistic regression and mediation analysis. RESULTS Of 224 included children, 54% were Black. Compared with non-Black children, Black children had 2.7 times greater odds of residual sleep apnea (95% confidence interval [CI]: 1.2, 6.1; p = .01), adjusted for age, sex, and baseline Apnea Hypopnea Index. There was significant effect modification by obesity. Among obese children, there was no association between Black race and outcome. However, nonobese Black children were 4.9 times as likely to have residual sleep apnea than non-Black children (95% CI: 1.2, 20.0; p < 0.01). There was no significant mediation by any of the child-level or socioeconomic factors tested. CONCLUSION There was substantial effect modification by obesity on the association between Black race and residual sleep apnea after adenotonsillectomy for mild-to-moderate sleep apnea. Black race was associated with poorer outcome among nonobese but not obese children.
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Affiliation(s)
- Shannon D Fayson
- Department of Otolaryngology, Head & Neck Surgery, Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Aleda M Leis
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan L Garetz
- Department of Otolaryngology, Head & Neck Surgery, Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Gary L Freed
- Department of Pediatrics, Susan B Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin M Kirkham
- Department of Otolaryngology, Head & Neck Surgery, Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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