The impact of home safety on sleep in a Latin American country

Associations between fears related to safety during sleep and self-reported sleep in men and women living in a low-socioeconomic status setting

South Africans living in low socioeconomic areas have self-reported unusually long sleep durations (approximately 9-10 h). One hypothesis is that these long durations may be a compensatory response to poor sleep quality as a result of stressful environments. This study aimed to investigate whether fear of not being safe during sleep is associated with markers of sleep quality or duration in men and women. South Africans (n = 411, 25-50 y, 57% women) of African-origin living in an urban township, characterised by high crime and poverty rates, participated in this study. Participants are part of a larger longitudinal cohort study: Modelling the Epidemiologic Transition Study (METS)-Microbiome. Customised questions were used to assess the presence or absence of fears related to feeling safe during sleep, and the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index were used to assess daytime sleepiness, sleep quality and insomnia symptom severity respectively. Adjusted logistic regression models indicated that participants who reported fears related to safety during sleep were more likely to report poor sleep quality (PSQI > 5) compared to participants not reporting such fears and that this relationship was stronger among men than women. This is one of the first studies outside American or European populations to suggest that poor quality sleep is associated with fear of personal safety in low-SES South African adults.

Perceived Neighborhood Characteristics and Sleep in Australian Adults

BACKGROUND

Poor sleep can contribute to poorer health and socioemotional outcomes. Sleep health can be influenced by a range of individual and other socioecological factors. Perceptions of neighborhood physical and social characteristics reflect broader social-level factors that may influence sleep, which have not been well studied in the Australian context. This study examined the association between perceived neighborhood characteristics and sleep in a large sample of Australians.

METHODS

Data were from 9,792 people aged 16 years or older, from Waves 16 and 17 of the nationally representative Household, Income and Labour Dynamics in Australia Survey. Associations between perceived neighborhood characteristics (neighborly interaction and support, environmental noise, physical condition, and insecurity) and self-reported sleep duration, sleep disturbance, and napping were examined using multiple logistic regression models.

RESULTS

"Neighborhood interaction and support" and "neighborhood physical condition" were not significantly associated with any sleep outcomes after adjusting for relevant covariates. However, "environmental noise" and "neighborhood insecurity" remained significantly associated with sleep duration and sleep disturbance. None of the neighborhood characteristics were associated with napping. Furthermore, associations did not significantly vary by gender.

CONCLUSIONS

This study highlights the potential benefit of public health policies to address noise and safety in neighborhoods to improve sleep.

Getting Good Sleep with Family Support: The Role of Fear of Crime and Loneliness

Sleep problems in middle-aged and older people can threaten their physical and mental health. Family support is regarded as a key factor that affects sleep quality, but the influence mechanism remains underexplored. This study analyzes the mediating effects of fear of crime (FOC) and loneliness in the relationship between family support and sleep quality, and explores whether gender plays a moderating role between family support and FOC. A questionnaire survey was conducted among 1043 Chinese middle-aged and older people aged 45-93 years. Using 10,000 bootstrapped samples, the study shows that middle-aged and older people who receive more family support have better sleep quality, and FOC and loneliness play mediating role in this association. Gender moderates the relationship between family support and FOC. Compared with men, family support for females has a greater impact on their FOC condition, and the mediating effect of family support on sleep quality through FOC is also greater among women. Family support can affect sleep quality through the chain mediating effect of FOC and loneliness for women. This study provides an in-depth understanding of the relationship between family support and sleep quality.

Moving toward Equitable Care for Sleep Apnea in the United States: Positive Airway Pressure Adherence Thresholds: An Official American Thoracic Society Policy Statement

Background: Positive airway pressure (PAP) is a highly effective treatment for obstructive sleep apnea (OSA), but adherence limits its efficacy. In addition, coverage of PAP by CMS (Centers for Medicare & Medicaid Services) and other insurers in the United States depends on adherence. This leaves many beneficiaries without PAP, disproportionally impacting non-white and low socioeconomic position patients with OSA and exacerbating sleep health disparities. Methods: An inter-professional, multidisciplinary, international committee with various stakeholders was formed. Three working groups (the historical policy origins, impact of current policy, and international PAP coverage models) met and performed literature reviews and discussions. Using surveys and an iterative discussion-based consensus process, the policy statement recommendations were created. Results: In this position paper, we advocate for policy change to CMS PAP coverage requirements to reduce inequities and align with patient-centered goals. We specifically call for eradicating repeat polysomnography, eliminating the 4-hour rule, and focusing on patient-oriented outcomes such as improved sleepiness and sleep quality. Conclusions: Modifications to the current policies for PAP insurance coverage could improve health disparities.

Polycystic ovary syndrome in Latin American populations: What is known and what remains unresolved

Polycystic ovary syndrome (PCOS) is one of the main endocrine and reproductive disorders affecting women in their reproductive age. The syndrome is considered a multifactorial pathology. Therefore, genetic susceptibility and environmental factors contribute to PCOS development and phenotypic manifestation. Ethnicity and socioeconomic factors influence the development of PCOS and could affect the possibility of its diagnosis. Latin America is a unique case of study because of the heterogeneity within the region, complex socioeconomic status, and the mixed ancestry found in these populations. Up-to-date, most studies have focused on developed countries' populations, and there is a lack of evidence regarding Latin-American countries. We propose to review the state of the art of PCOS knowledge regarding Latin American populations, including the metabolic and reproductive aspects of the syndrome and the different influencing factors, and suggest future directions to deepen the study of PCOS.

Sound reasons for unsound sleep: Comparative support for the sentinel hypothesis in industrial and nonindustrial groups

Background and objectives

Sleep is a vulnerable state in which individuals are more susceptible to threat, which may have led to evolved mechanisms for increasing safety. The sentinel hypothesis proposes that brief awakenings during sleep may be a strategy for detecting and responding to environmental threats. Observations of sleep segmentation and group sentinelization in hunter-gatherer and small-scale communities support this hypothesis, but to date it has not been tested in comparisons with industrial populations characterized by more secure sleep environments.

Methodology

Here, we compare wake after sleep onset (WASO), a quantitative measure of nighttime awakenings, between two nonindustrial and two industrial populations: Hadza hunter-gatherers (n = 33), Malagasy small-scale agriculturalists (n = 38), and Hispanic (n = 1,531) and non-Hispanic White (NHW) (n = 347) Americans. We compared nighttime awakenings between these groups using actigraphically-measured sleep data. We fit linear models to assess whether WASO varies across groups, controlling for sex and age.

Results

We found that WASO varies significantly by group membership and is highest in Hadza (2.44 h) and Malagasy (1.93 h) and lowest in non-Hispanic Whites (0.69 h). Hispanics demonstrate intermediate WASO (0.86 h), which is significantly more than NHW participants. After performing supplementary analysis within the Hispanic sample, we found that WASO is significantly and positively associated with increased perception of neighborhood violence.

Conclusions and implications

Consistent with principles central to evolutionary medicine, we propose that evolved mechanisms to increase vigilance during sleep may now be mismatched with relatively safer environments, and in part responsible for driving poor sleep health.

Associations between sleep duration and Mediterranean diet score in Costa Rican adults

Both insufficient and excessive sleep duration have been associated with lower-quality diets in adult populations. However, investigations in Latin America, where different sleep norms may exist (e.g., daily napping), are scarce. Therefore, we examined whether weekday sleep duration and inconsistencies between weekday and weekend sleep duration were related to adherence to the Mediterranean diet among Costa Rican adults. The study population included 2169 controls (74% men) from a population-based case-control study. Usual sleep duration (weekday versus weekend) was self-reported and defined as short, recommended, and long (<7 h, 7-9 h, >9 h, respectively). Inconsistent weekday-weekend sleep duration was defined as >1-h difference. Diet was assessed with a food frequency questionnaire, and adherence to the Mediterranean diet was calculated with the Alternative Mediterranean Diet Score (AMED). Sex-stratified linear regression models were conducted with AMED score as a continuous outcome and sleep variables as categorical or dichotomous exposures (in separate models). Models were adjusted for age, area of residence, education, napping, caffeine intake, smoking status, type 2 diabetes mellitus, hypertension, and physical activity. Average (SD) hours of sleep per night reported were 7.0 (1.4) on weekdays and 7.3 (1.6) on weekends for men, and 7.0 (1.5) on weekdays and 7.2 (1.6) on weekends for women. Among women, sleep duration <7-h per night was associated with a lower AMED score compared to those with recommended sleep duration (β: -0.35, CI: -0.63 to -0.07). Unstratified models showed a suggestive association between inconsistent weekday-weekend sleep and lower AMED scores that did not vary by sex (β: -0.08, CI: -0.16, 0.006; P, interaction with sex = 0.93). Lastly, the napping frequency was not associated with AMED scores in any model. In conclusion, short and inconsistent sleep duration may affect the dietary patterns of Costa Ricans.

Housing insecurity and sleep among welfare recipients in California

STUDY OBJECTIVES

To estimate the effect of housing insecurity on sleep duration and sleep quality.

METHODS

Using longitudinal data from a sample of 1,046 welfare recipients in the state of California followed from 2015-2016 through 2017-2018, we regressed self-reported measures of sleep duration and sleep quality recorded in 2017-2018 on experiences of housing insecurity in the prior year. We applied propensity score weights to attenuate potential bias from an array of observed covariates, including sleep duration and sleep quality measured prior to experiences with housing insecurity.

RESULTS

Sample members who were unable to make their rent/mortgage payments slept on average 22 fewer minutes a night and had lower quality sleep than those who were able to make their rent/mortgage payments. Sample members who were forced to move because of an inability to make rent/mortgage payments slept on average 32 fewer minutes a night and had lower quality sleep than those who were not forced to move.

CONCLUSIONS

By compromising sleep health, housing insecurity represents a distinct form of stress in the lives of economically-disadvantaged adults, which could also contribute to other health disparities.

Neighborhood Social Cohesion and Sleep Health by Age, Sex/Gender, and Race/Ethnicity in the United States

Although low neighborhood social cohesion (nSC) has been linked with poor sleep, studies of racially/ethnically diverse participants using multiple sleep dimensions remain sparse. Using National Health Interview Survey data, we examined overall, age, sex/gender, and racial/ethnic-specific associations between nSC and sleep health among 167,153 adults. Self-reported nSC was categorized into low, medium, and high. Very short sleep duration was defined as <6 h; short as <7 h, recommended as 7–9 h, and long as ≥9 h. Sleep disturbances were assessed based on trouble falling and staying asleep, waking up feeling unrested, and using sleep medication (all ≥3 days/times in the previous week). Adjusting for sociodemographics and other confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for sleep dimensions by low and medium vs. high nSC. The mean age of the sample was 47 ± 0.1 years, 52% of those included were women, and 69% were Non-Hispanic (NH)-White. Low vs. high nSC was associated with a higher prevalence of very short sleep (PR = 1.29; (95% CI = 1.23–1.36)). After adjustment, low vs. high nSC was associated with very short sleep duration among NH-White (PR = 1.34 (95% CI = 1.26–1.43)) and NH-Black (PR = 1.14 (95% CI = 1.02–1.28)) adults. Low nSC was associated with shorter sleep duration and sleep disturbances.

Childhood Adversity and Sleep Disturbances: Longitudinal Results in Puerto Rican Children

BACKGROUND

Exposure to childhood adversities (CA) is associated with sleep disturbances; however, evidence has largely been drawn from cross-sectional data and has not addressed the relationship across developmental stages. Also, most studies have primarily focused on non-Hispanic White cohorts with a dearth of longitudinal evidence about racial/ethnic minorities. We examined the longitudinal association between CA and sleep disturbances in Puerto Rican youth.

METHOD

The Boricua Youth Study is a longitudinal study of Puerto Rican youth living in San Juan, Puerto Rico, and the South Bronx, NY (N = 2491). Among youth 5-9 and 10-16 years old, sleep disturbances were assessed through three yearly interviews. Lifetime exposure to CA included parental loss, child maltreatment, parental maladjustment, and exposure to violence. Weighted generalized linear mixed models examined the longitudinal association between CA and sleep disturbances in youth adjusting for sociodemographic and contextual covariates.

RESULTS

The prevalence of sleep disturbances was similar in both age groups (ages 5-9 and 10-16). In multivariable mixed models, CA were associated with sleep disturbance across three Waves among 10-16-year-olds. For example, having 2-3 or ≥ 4 types of CA were related to a higher prevalence of trouble falling/staying asleep in models adjusting for social context, gender, welfare status, or mother's education. No associations were observed among 5-9-year-olds.

CONCLUSION

The results suggest that cumulative adversities in childhood may lead to sleep problems in adolescence. These findings highlight the utility of addressing CA during childhood to help reduce sleep-wake disorders throughout adolescence, a known risk factor for future mental and physical health problems.

Neighborhood disadvantage is associated with actigraphy-assessed sleep continuity and short sleep duration

Study Objectives

Neighborhood disadvantage has been linked to poor sleep. However, the extant research has primarily focused on self-reported assessments of sleep and neighborhood characteristics. The current study examines the association between objective and perceived neighborhood characteristics and actigraphy-assessed sleep duration, efficiency, and wakefulness after sleep onset (WASO) in an urban sample of African American adults.

Methods

We examined data from predominantly African American adults (n = 788, mean age 55 years; 77% female) living in two low-income neighborhoods. Perceived neighborhood characteristics included safety, social cohesion, and satisfaction with one's neighborhood as a place to live. Objective neighborhood conditions included walkability, disorder, street lighting, and crime levels. Sleep duration, efficiency, and WASO were measured via 7 days of wrist-worn actigraphy. Analyses estimated each of the sleep outcomes as a function of perceived and objective neighborhood characteristics. Individual-level sociodemographics, body mass index, and psychological distress were included as covariates.

Results

Greater perceived safety was associated with higher sleep efficiency and shorter WASO. Greater neighborhood disorder and street lighting were associated with poorer sleep efficiency and longer WASO and greater likelihood of short sleep duration (<7 versus 7-9 hr as referent). Higher levels of crime were associated with poorer sleep efficiency and longer WASO, but these associations were only evident in one of the neighborhoods.

Conclusions

Both how residents perceive their neighborhood and their exposure to objectively measured neighborhood disorder, lighting, and crime have implications for sleep continuity. These findings suggest that neighborhood conditions may contribute to disparities in sleep health.

The Effect of Sleeping Environment and Sleeping Location Change on Positive Airway Pressure Adherence

STUDY OBJECTIVES

Poor adherence undermines the effectiveness of positive airway pressure (PAP) therapy for sleep apnea. Disparities exist in PAP adherence by race/ethnicity and neighborhood socioeconomic status (SES), but the etiology of these differences is poorly understood. We investigated whether home environmental factors contribute to PAP adherence and whether identified factors explain disparities in adherence by SES.

METHODS

Adult patients with sleep apnea were surveyed at clinic visits about their sleep environment. Medical records were abstracted for demographic data, sleep apnea severity, comorbidities, and objective PAP adherence. We evaluated the association between aspects of home sleep environment with PAP adherence using multivariate linear and logistic regression, and assessed effect modification by SES factors.

RESULTS

Participants (n = 119) were diverse, with 44% nonwhite and 35% uninsured/Medicaid. After adjusting for age, sex, race/ethnicity, insurance, neighborhood SES, education, and marital status, participants who endorsed changing sleeping location once per month or more (18%, n = 21) had 77% lower odds of meeting PAP adherence criteria (> 4 h/night for 70% of nights) and less PAP use (median -11 d/mo, 95% confidence intervals -15.3, -6.5). Frequency of sleeping location change was the only environmental factor surveyed associated with PAP adherence.

CONCLUSIONS

Frequent change in sleeping location is associated with reduced PAP adherence, independent of sociodemographic factors. This novel finding has implications for physician-patient dialogue. PAP portability considerations in device selection and design may modify adherence and potentially improve treatment outcomes. Prospective investigation is needed to confirm this finding and inform design of possible interventions.

Environmental Determinants of Insufficient Sleep and Sleep Disorders: Implications for Population Health

PURPOSE OF REVIEW

Sleep is important for overall health and well-being. Insufficient sleep and sleep disorders are highly prevalent among adults and children and therefore a public health burden, particularly because poor sleep is associated with adverse health outcomes. Emerging evidence has demonstrated that environmental factors at the household- and neighborhood-level can alter healthy sleep. This paper will (1) review recent literature on the environmental determinants of sleep among adults as well as children and adolescents; and (2) discuss the opportunities and challenges for advancing research on the environment and sleep.

RECENT FINDINGS

Epidemiologic research has shown that social features of environments, family, social cohesion, safety, noise, and neighborhood disorder can shape and/or impact sleep patterns; and physical features such as light, noise, traffic, pollution, and walkability can also influence sleep and is related to sleep disorders among adults and children. Prior research has mainly measured one aspect of the environment, relied on self-reported sleep, which does not correlate well with objective measures, and investigated cross-sectional associations. Although most studies are conducted among non-Hispanic white populations, there is growing evidence that indicates that minority populations are particularly vulnerable to the effects of the environment on insufficient sleep and sleep disorders.

SUMMARY

There is clear evidence that environmental factors are associated with insufficient sleep and sleep disorders. However, more research is warranted to evaluate how and which environmental factors contribute to sleep health. Interventions that target changes in the environment to promote healthy sleep should be developed, tested, and evaluated as a possible pathway for ameliorating sleep health disparities and subsequently health disparities.

The Neighborhood Social Environment and Objective Measures of Sleep in the Multi-Ethnic Study of Atherosclerosis

Study objectives

To investigate cross-sectional associations of neighborhood social environment (social cohesion, safety) with objective measures of sleep duration, timing, and disturbances.

Methods

A racially/ethnically diverse population of men and women (N = 1949) aged 54 to 93 years participating in the Multi-Ethnic Study of Atherosclerosis Sleep and Neighborhood Ancillary studies. Participants underwent 1-week actigraphy between 2010 and 2013. Measures of sleep duration, timing, and disruption were averaged over all days. Neighborhood characteristics were assessed via questionnaires administered to participants and an independent sample within the same neighborhood and aggregated at the neighborhood (census tract, N = 783) level using empirical Bayes estimation. Multilevel linear regression models were used to assess the association between the neighborhood social environment and each sleep outcome.

Results

Neighborhood social environment characterized by higher levels of social cohesion and safety were associated with longer sleep duration and earlier sleep midpoint. Each 1 standard deviation higher neighborhood social environment score was associated with 6.1 minutes longer [95% confidence interval (CI): 2.0, 10.2] sleep duration and 6.4 minutes earlier (CI: 2.2, 10.6) sleep midpoint after adjustment for age, sex, race, socioeconomic status, and marital status. These associations persisted after adjustment for other risk factors. Neighborhood social factors were not associated with sleep efficiency or sleep fragmentation index.

Conclusions

A more favorable neighborhood social environment is associated with longer objectively measured sleep duration and earlier sleep timing. Intervening on the neighborhood environment may improve sleep and subsequent health outcomes.

Neighborhood Factors as Predictors of Poor Sleep in the Sueño Ancillary Study of the Hispanic Community Health Study/Study of Latinos

Study Objectives

To evaluate whether an adverse neighborhood environment has higher prevalence of poor sleep in a US Hispanic/Latino population.

Methods

A cross-sectional analysis was performed in 2156 US Hispanic/Latino participants aged 18-64 years from the Sueño ancillary study of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Participants completed surveys of neighborhood environment including perceived safety, violence and noise, the Insomnia Severity Index (ISI), and 7 days of wrist actigraphy.

Results

In age and sex-adjusted analyses, short sleep, low sleep efficiency, and late sleep midpoint were all more prevalent among those living in an unsafe neighborhood. After adjustment for background, site, nativity, income, employment, depressive symptoms, and sleep apnea, the absolute risk of sleeping <6 hours was 7.7 (95% CI [0.9, 14.6]) percentage points greater in those living in an unsafe compared to a safe neighborhood. There were no differences in the prevalence of insomnia by level of safety or violence. Insomnia was more prevalent among those living in a noisy neighborhood. In adjusted analysis, the absolute risk of insomnia was 4.4 (95% CI [0.4, 8.4]) percentage points greater in those living in noisy compared to non-noisy neighborhoods.

Conclusion

Using validated measures of sleep duration and insomnia, we have demonstrated the existence of a higher prevalence of short sleep and insomnia by adverse neighborhood factors. An adverse neighborhood environment is an established risk factor for a variety of poor health outcomes. Our findings suggest negative effects on sleep may represent one pathway by which neighborhood environment influences health.

Community violence concerns and adolescent sleep

OBJECTIVE

The goal of this study was to examine links between concerns about community violence and objective and subjective sleep parameters in an adolescent sample. Sex was considered as a moderator of effects.

DESIGN

The study used a cross-sectional design.

PARTICIPANTS

The community-based sample included 252 adolescents (53% girls) with an average age of 15.79 years (SD = 0.81) from the Southeastern United States. The sample included 34% African American and 66% European American adolescents from a wide range of socioeconomic backgrounds.

MEASUREMENTS

Adolescent-reported community violence concerns were assessed using a composite of 3 separate subscales that measured perceived community safety and threats of community and school violence. Sleep duration and quality were assessed using actigraphy, and subjective sleep problems and daytime sleepiness were measured with subscales of the School Sleep Habits Survey.

RESULTS

Community violence predicted lower sleep efficiency, more long-wake episodes, and more sleep/wake problems and sleepiness. Sex-related moderation effects revealed that girls in the sample were more vulnerable to the effects of violence concerns on their objective sleep quality.

CONCLUSIONS

Findings highlight the role of community violence concerns on adolescents' sleep, revealing that greater community violence concerns are linked with lower levels of actigraphy-based and subjective reports of sleep quality, particularly for adolescent girls. Consideration of the mechanisms by which violence concerns may affect sleep is discussed.

Recent Updates in the Social and Environmental Determinants of Sleep Health

In this brief review article, we provide an overview of recent (since 2010) scientific contributions to our understanding of the social and environmental determinants of sleep health. In particular, we focus on three areas where we saw the most contributions to the determinants of sleep health among children, adolescents, and adults. First, studies of neighborhood context and sleep health find that sleep quality and quantity are lower in disadvantaged neighborhoods. These negative associations are often stronger for women than for men. Second, family factors matter for sleep health. Children from families with more parental resources sleep better than do children from families without such resources. Adults with children sleep less than those without, and work-family conflict is an impediment to good sleep. Third, media use is problematic for sleep health. Around the world, higher levels of screen media use are associated with lower quality and quantity of sleep. Future research on the social and environmental determinants of sleep health will grow out of these three areas of current research. In addition, we anticipate new research in the international realm and in the area of interventions designed to improve the population's sleep health.

The association of neighborhood characteristics with sleep duration and daytime sleepiness

BACKGROUND

Neighborhood characteristics have been linked to health outcomes. Various mechanisms link neighborhoods and health outcomes; sleep patterns may be 1 contributor; however, little is known about the social determinants of disordered sleep. We examined the association of neighborhood characteristics with sleep duration and daytime sleepiness.

METHODS

Participants (n = 801) enrolled as pairs (55 without pair), from 10 churches in the Stroke Health and Risk Education project; 760 were included for analysis (41 withdrew). Sleep duration (hours of sleep at night) and daytime sleepiness (adaptation of Berlin questionnaire; range, 0-3 [more daytime sleepiness]) were self-reported. Neighborhood characteristics included disadvantage, per capita violent crime (census tract level), and safety (self-reported and individual level). We fit generalized linear mixed models and multinomial and binomial logistic regression models to examine the associations between neighborhood characteristics and sleep outcomes while accounting for the clustering within churches and pairs, before and after adjustment for self-reported confounders (age, gender, income, education, body mass index, depressive symptoms, hypertension, and diabetes).

RESULTS

The mean hours of sleep duration is 6.7 ± 1.2, and the mean daytime sleepiness is 0.8 ± 0.9. Neighborhood characteristics were not associated with sleep duration. Higher perceived neighborhood safety was associated with an 18.4% lower odds of daytime sleepiness in the unadjusted model (odds ratio, 0.82 [95% confidence interval, 0.69-0.96]). The association was attenuated in the fully adjusted model. Neighborhood disadvantage and violent crime were related to lower daytime sleepiness; however, associations were not statistically significant.

CONCLUSION

Self-reported neighborhood safety was associated with lower daytime sleepiness. Future exploration of the pathways linking neighborhood characteristics and sleep is warranted.