Habitual sleep as a contributor to racial differences in cardiometabolic risk

Edited by Susan Redline, Brigham and Women’s Hospital, Boston, MA, and accepted by Editorial Board Member Gregg L. Semenza June 28, 2017 (received for review November 3, 2016)
July 31, 2017
114 (33) 8889-8894

Significance

Large differences in cardiovascular disease and diabetes prevalence exist between African American and European American adults. The US federal government has committed to reducing racial disparities in health; however, the precise mechanisms are not well understood. Sleep is one potential behavioral explanation for current racial differences in cardiometabolic conditions. We show that more than one-half of racial differences in cardiometabolic risk can be explained by sleep patterns—namely, less total sleep and lower sleep efficiency among African American than European American adults. Sleep is a malleable health behavior that is linked with characteristics of the social and physical environment and could be an effective target in national efforts to reduce racial health disparities.

Abstract

Insufficient and disrupted sleep is linked with cardiovascular and metabolic dysregulation and morbidity. The current study examines the degree to which differences in sleep between black/African American (AA) and white/European American (EA) adults explain racial differences in cardiometabolic (CMB) disease risk. Total sleep time and sleep efficiency (percent of time in bed asleep) were assessed via seven nights of wrist actigraphy among 426 participants in the Midlife in the United States Study (31% AA; 69% EA; 61% female; mean age = 56.8 y). CMB risk was indexed as a composite of seven biomarkers [blood pressure, waist circumference, hemoglobin A1c (HbA1c), insulin resistance, triglycerides, HDL cholesterol (HDL-C), and C-reactive protein]. Covariates included sociodemographic characteristics and relevant health behaviors. Results indicated that AAs relative to EAs obtained less sleep (341 vs. 381 min) and had lower sleep efficiency (72.3 vs. 82.2%) (P values < 0.001). Further, 41% and 58% of the racial difference in CMB risk was explained by sleep time and sleep efficiency, respectively. In models stratified by sex, race was indirectly associated with CMB risk via sleep time and efficiency only among females (explaining 33% and 65% of the race difference, respectively). Indirect effects were robust to alternative model specifications that excluded participants with diabetes or heart disease. Consideration of sleep determinants and sleep health is therefore needed in efforts to reduce racial differences in CMB disease.

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Data Availability

Data deposition: Data reported in this paper are publicly available at https://www.icpsr.umich.edu/icpsrweb/ICPSR/studies/29282.

Acknowledgments

This research was supported by the National Institute of Aging Grant P01-AG020166, by funding for a longitudinal follow-up of the original Midlife in the United States Study, and by the Clinical and Translational Science Program (University of Wisconsin-Madison) of the National Center for Research Resources, National Institutes of Health (Grant 1UL1RR025011).

Supporting Information

Supporting Information (PDF)

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Information & Authors

Information

Published in

Go to Proceedings of the National Academy of Sciences
Proceedings of the National Academy of Sciences
Vol. 114 | No. 33
August 15, 2017
PubMed: 28760970

Classifications

Data Availability

Data deposition: Data reported in this paper are publicly available at https://www.icpsr.umich.edu/icpsrweb/ICPSR/studies/29282.

Submission history

Published online: July 31, 2017
Published in issue: August 15, 2017

Keywords

  1. health disparities
  2. race
  3. sleep
  4. cardiometabolic disease
  5. health behaviors

Acknowledgments

This research was supported by the National Institute of Aging Grant P01-AG020166, by funding for a longitudinal follow-up of the original Midlife in the United States Study, and by the Clinical and Translational Science Program (University of Wisconsin-Madison) of the National Center for Research Resources, National Institutes of Health (Grant 1UL1RR025011).

Notes

This article is a PNAS Direct Submission. S.R. is a guest editor invited by the Editorial Board.

Authors

Affiliations

Department of Human Development and Family Studies, Auburn University, Auburn, AL 36849;
Thomas E. Fuller-Rowell
Department of Human Development and Family Studies, Auburn University, Auburn, AL 36849;
Mona El-Sheikh
Department of Human Development and Family Studies, Auburn University, Auburn, AL 36849;
Mercedes R. Carnethon
Department of Preventive Medicine, Northwestern University, Evanston, IL 60611;
Carol D. Ryff
Department of Psychology, University of Wisconsin-Madison, Madison, WI 53706

Notes

1
To whom correspondence should be addressed. Email: [email protected].
Author contributions: D.S.C., T.E.F.-R., M.E.-S., M.R.C., and C.D.R. designed research; D.S.C. and C.D.R. performed research; D.S.C. and T.E.F.-R. analyzed data; and D.S.C., T.E.F.-R., M.E.-S., M.R.C., and C.D.R. wrote the paper.

Competing Interests

The authors declare no conflict of interest.

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    Habitual sleep as a contributor to racial differences in cardiometabolic risk
    Proceedings of the National Academy of Sciences
    • Vol. 114
    • No. 33
    • pp. 8661-E7031

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