Immigration transition and sleep-related symptoms experienced during menopausal transition

Menopause in a globalized world - A systematic literature review focussing on the challenge of health problems associated with menopausal transition among women with a migration background

Globalization and international migration movements have massively changed the population structure of most industrial nations in recent decades. The ever-increasing proportion of people with a migration background also poses a challenge for the medical sector. A particular problem is the stressful phase of the menopausal transition, which - although not a pathological phenomenon but part of the female life history - can lead to psychological and physical symptoms due to hormonal changes, which significantly impair the quality of life of the women affected. However, treatment concepts, as well as access to medical facilities and information, are geared towards Western women from high-income countries. Women with a history of voluntary or forced migration originating from non-Western countries represent a particularly vulnerable group. To enable personalized treatment, studies on menopausal transition in women with a migration background are required. The present review shows that studies on menopausal women with a migration background have been conducted primarily in classic immigration countries such as the USA, Australia, or the UK, but that there is a lack of such studies in countries with no long tradition as an immigration country, such as Austria or Germany. This is becoming a growing problem, as the number of menopausal women with a migration background is increasing.

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.

Cardiovascular diseases and sleep disorders in South Asians: A scoping review

BACKGROUND

South Asians comprise 20% of the world population. There is a high prevalence of cardiovascular diseases among South Asians, and sleep disorders may be a key risk factor.

OBJECTIVE

The review examined literature about cardiovascular and sleep disorders in South Asian countries and in the United States, United Kingdom, Canada, and the Netherlands.

METHODS

Methods from Arksey and O'Malley's framework and Peter et al. were used to synthesize findings from 23 research studies.

RESULTS

The studies addressed sleep disorders with hypertension, heart failure, diabetes, and obesity. Obstructive sleep apnea and short sleep duration were common and associated with cardiovascular morbidity and mortality at early ages in South Asians. Researchers analyzed polysomnography-derived sleep measures, vascular functions, polymorphisms, C-reactive protein levels, public knowledge about cardiovascular health, and sleep-related questionnaire scores. Most studies were conducted in major metropolitan areas; no data were available about people living in locations with limited health care resources. Among migrant South Asians, researchers did not explore the role of acculturation on sleep patterns and cardiovascular outcomes.

CONCLUSIONS

The review highlights important considerations for researchers who plan to investigate cardiovascular conditions in South Asian communities. There is a need for more knowledge about sleep-related risk factors, and researchers should also examine cultural, political, and socioeconomic factors that affect health care access. This knowledge will be imperative for designing effective and tailored disease prevention strategies for South Asian populations.

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.

Physiologic and psychosocial changes of the menopause transition in US Latinas: a narrative review

Latinos comprise the fastest-growing minority group in the USA, with Hispanic women (Latinas) constituting 17% of women aged 45-54 years. The menopause transition (MT) is associated with many physiological, behavioral, and psychosocial changes that can affect disease risk in women. While several epidemiologic investigations have enhanced our understanding of the MT, to date, menopause research has mostly focused on non-Latina White women. As a consequence, there is a dearth of information on strategies for managing menopause-related issues in Latinas and important factors to consider to provide culturally appropriate care and promote lifestyles that may reduce adverse health outcomes. This narrative review summarizes existing evidence of the MT in Latinas, with a focus on hormonal alterations, menopausal symptoms, mental health, cognition, and cardiometabolic health. The clinical and research implications of the current literature will also be discussed.

Menopausal transition experiences and management strategies of Chinese immigrant women: a scoping review

IMPORTANCE AND OBJECTIVE

Chinese immigrants are among some of the fastest growing groups in many Western countries, and experience challenges such as language barriers, education gaps, and gender discrimination, which highlights the need for special attention and consideration in Western health care. The purpose of this scoping review is to summarize existing research on the menopausal experiences of Chinese immigrant women (CIW).

METHODS

This scoping review was written in accordance with PRISMA guidelines. MEDLINE, PsycINFO, CINAHL, AgeLine, ERIC, ProQuest, Nursing and Allied Health Database, PsycARTICLES, Sociology Database, and Education Research Complete were utilized for the literature search. Articles were included if they examined CIW experiencing menopausal transition. A total of 18 studies were included for review.

DISCUSSION AND CONCLUSION

Findings suggested that CIW experienced a variety of physical symptoms, including muscle and joint pain, urogenital symptoms, vasomotor symptoms, weight gain, decreased physical strength, vision changes, and skin changes. Muscle and joint pain were particularly prevalent and emphasized. CIW also experienced psycho-behavioral symptoms including emotional changes, depression, memory loss, and sexual dysfunction. However, they had a decreased concern regarding symptoms of sexual dysfunction and decreased libido when compared with women from Western cultures. CIW interpreted menopause as a natural aging process involving the next step in life. Cultural expectations of stoicism and silence may cause immigrant women to be less vocal about their menopause experiences and result in feelings of loneliness. Acculturation may be both a facilitator and a barrier to a healthy menopausal transition. CIW were resistant to Western Medicine management such as hormone therapy but were willing to incorporate traditional medicine into their health care. They believed that a healthy mentality was important and used various psychocognitive strategies to maintain a good quality of life. Healthcare providers, researchers, and policymakers need to consider the unique characteristics of CIW's menopausal transition in research, intervention innovation, and practice.

Immigration Transition and Cognitive Symptoms During Menopausal Transition

Many studies have been conducted to investigate the effect of cultural influences on menopausal symptoms; however, associations between immigration transition and cognitive symptoms have rarely been uncovered. This secondary analysis aimed to determine these associations among 1,054 midlife women in the United States using the data from two national Internet surveys. The surveys included multiple questions on immigration transition, health and menopausal status, and the Cognitive Symptom Index for Midlife Women. The data analysis was performed using descriptive and inferential statistics including hierarchical multiple regression analyses. Nonimmigrants had larger numbers and higher severity scores of total cognitive symptoms than immigrants (p < .001). Immigration status explained 1.28% of the total variances in the total numbers and 1.46% of the total variances in the total severity scores of total cognitive symptoms (p < .001). The study supported significant associations between immigration transition and cognitive symptoms of women at midlife.