Sleep quality and cultural orientation among Chinese and Korean undergraduates in the United States

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.

Profiles of Ethnic-Racial Identity, Socialization, and Model Minority Experiences: Associations with Well-Being Among Asian American Adolescents

Ethnic-racial identity, ethnic-racial socialization, and racialized experiences are fundamental to the development of youth of color. However, most prior studies have examined their developmental impact in isolation. The present study fills this gap using a person-centered approach to elucidate patterns of ethnic-racial identity, socialization, and model minority experiences among 145 Asian American adolescents (Mage = 14.3, SD = 0.59; 65% female). Three distinct profiles were identified. Overall, adolescents with stronger ethnic-racial identity and more cultural socialization but less preparation for bias (Salient, 13%) demonstrated better psychosocial and academic outcomes. Adolescents with moderate levels on the six indicators of ethnic-racial identity, socialization, and model minority experiences (Moderate, 72%) reported better sleep quality and less delinquency. Adolescents with low levels of ethnic-racial identity and cultural socialization but greater preparation for bias (Marginal, 15%) had the least adaptative outcomes across all domains. The findings observed the heterogeneity of ethnic-racial experiences within the Asian American group and highlighted the importance of examining the combined influences of ethnic-racial identity, socialization, and model minority experiences on health and well-being among Asian American adolescents from a multidimensional perspective.

Sleep-Wake Timings in Adolescence: Chronotype Development and Associations with Adjustment

Adolescent sleep research has focused heavily on duration and quality with less work examining chronotype, defined as individual differences in sleep-wake timings driven by the circadian rhythm. This study filled a gap in the literature by utilizing actigraphy-based sleep estimates in an accelerated longitudinal design in order to better understand the developmental trajectory and individual stability of chronotype during adolescence, as well as the associations between chronotype with risky behaviors, substance use, and depressive symptoms. A total of 329 adolescents (57% female; 21% Asian American, 31% European American, 41% Latino, 7% other ethnicity) provided actigraphy-based estimates of sleep and completed questionnaires at up to three time points, two years apart, beginning at 14-17 years of age. Multilevel modeling revealed a non-linear developmental trend in chronotype whereby eveningness increased from 14 to 19 years of age followed by a trend toward morningness. Individual differences in chronotype exhibited modest stability during adolescent development. Furthermore, greater evening chronotype was associated with more risky behaviors and substance use among males, and more substance use among older adolescents, whereas depressive symptoms were not associated with chronotype. The findings from this study may have practical implications for adolescent behavioral health interventions targeted at reducing risky behaviors and substance use among youth.