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Sleep disorders in migrants and refugees: a systematic review with implications for personalized medical approach

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Abstract

Background

Sleep disorders are very common in migrants and refugees, often as a comorbid disorder to different somatic or psychiatric diagnoses and psychological disturbances such as metabolic syndrome, post-traumatic stress disorder, depression, and anxiety disorders.

Objectives

To review published prevalence rates as well as possible predictors for sleep disturbances in these vulnerable groups, including pre-migration stress, acculturation, and trauma before, during, and after migration, integration, and lifestyle in the host country with implications for predictive, preventive, and personalized medical approach (3PM).

Data sources

Electronic databases PubMed, PsycInfo, and Web of Knowledge were searched using (combined) search terms “migrant,” “asylum seeker,” “refugee,” “sleep disturbances,” “sleep disorder,” “insomnia,” and “sleep wake disorder.”

Study eligibility criteria

Peer-reviewed studies from 2000 to 2018 reporting data on prevalence and/or predictors of any measure of sleep disturbance were included.

Participants

Studies on international migrants and refugees, as well as internally displaced populations, were included.

Methods

We conducted a systematic review on the topic of sleep disorders in migrant and refugee populations. Only published articles and reviews in peer-reviewed journals were included.

Results

We analyzed five studies on sleep disorders in migrants, five studies on adult refugees, and three on refugee children and adolescents. Prevalence of sleep disorders in migrants and refugees ranges between 39 and 99%. In migrant workers, stress related to integration and adaptation to the host society is connected to higher risks of snoring, metabolic diseases, and insomnia. Sleep disturbances in refugees are predicted by past war experience. Sleep difficulties in adult and child refugees are strongly correlated to trauma. Torture of parents and grandparents can predict sleep disorders in refugee children, while being accompanied by parents to the host country has a protective effect on children’s sleep.

Conclusions and implications

Considering the differences in risk factors, vulnerability, and traumatic life events for different migrant populations, origins of sleep difficulties vary, depending on the migrant populations. Effects on sleep disturbances and sleep quality may be a result of integration in the host country, including changes of lifestyle, such as diet and working hours with implication for OSAS (obstructive sleep apnea) and insomnia. Compared with migrant populations, sleep disturbances in refugee populations are more correlated with mental health symptoms and disorders, especially PTSD (post-traumatic stress disorder), than with psychosocial problems. In juvenile refugee populations, psychological problems and disturbed sleep are associated with traumatic experiences during their journey to the host country. Findings highlight the need for expert recommendations for development of 3P approach stratified in the following: (1) prediction, including structured exploration of predisposing and precipitating factors that may trigger acute insomnia, screening of the according sleep disorders by validated translated questionnaires and sleep diaries, and a face-to-face or virtual setting and screening of OSAS; (2) target prevention by sleep health education for female and male refugees and migrant workers, including shift workers; and (3) personalized medical approach, including translated cognitive behavioral treatment for insomnia (CBT-I) and imagery rehearsal therapy for refugees and telehealth programs for improved CPAP adherence in migrants, with the goal to enable better sleep health quality and improved health economy.

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Authors and Affiliations

  1. University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany

    Kneginja Richter, Lisa Baumgärtner, Günter Niklewski, Lukas Peter, Melanie Köck & Thomas Hillemacher

  2. Faculty for Social Work, Technical University Nuremberg Georg Simon Ohm, Nuremberg, Germany

    Kneginja Richter, Lukas Peter & Stefanie Kellner

  3. Faculty for medical sciences, University Goce Delcev, Stip, Macedonia

    Kneginja Richter & Günter Niklewski

  4. Institute of Cognitive Science, Woosuk University, Wanju, South Korea

    Antje Büttner-Teleaga

  5. Department of Psychiatry, University Witten-Herdecke, Witten, Germany

    Antje Büttner-Teleaga

Authors
  1. Kneginja Richter
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  2. Lisa Baumgärtner
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  3. Günter Niklewski
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  4. Lukas Peter
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  5. Melanie Köck
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  6. Stefanie Kellner
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  8. Antje Büttner-Teleaga
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Correspondence to Kneginja Richter.

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The study involves only review of literature without involving of human and/or animals. The authors have no ethical conflicts to disclose.

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Richter, K., Baumgärtner, L., Niklewski, G. et al. Sleep disorders in migrants and refugees: a systematic review with implications for personalized medical approach. EPMA Journal 11, 251–260 (2020). https://doi.org/10.1007/s13167-020-00205-2

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