Elsevier

Sleep Medicine

Volume 18, February 2016, Pages 88-95
Sleep Medicine

Review Article
Discrimination and sleep: a systematic review

https://doi.org/10.1016/j.sleep.2015.01.012Get rights and content

Research Highlights

  • We identified 17 studies on the relationship between discrimination and sleep.

  • All 17 studies found at least one association between discrimination and worse sleep.

  • Studies with more detailed exposures and outcomes revealed some inconsistencies.

  • Longitudinal designs and studies using objective sleep assessments are needed.

Abstract

An increasing body of literature indicates that discrimination has a negative impact on health; poor sleep may be an underlying mechanism. The primary objective of this review was to examine existing studies on the relationship between discrimination and sleep to clarify (a) the potential role of discrimination in shaping population patterns of sleep and sleep disparities, and (b) the research needed to develop interventions at individual and institutional levels. We identified articles from English-language publications in PubMed and EBSCO databases from inception through July 2014. We employed a broad definition of discrimination to include any form of unfair treatment and all self-reported and objectively assessed sleep outcomes, including duration, difficulties, and sleep architecture. Seventeen studies were identified: four prospective, 12 cross-sectional, and one that utilized a daily-diary design. Fifteen of the 17 studies evaluated interpersonal discrimination as the exposure and the majority of studies included self-reported sleep as the outcome. Only four studies incorporated objective sleep assessments. All 17 studies identified at least one association between discrimination and a measure of poorer sleep, although studies with more detailed consideration of either discrimination or sleep architecture revealed some inconsistencies. Taken together, existing studies demonstrate consistent evidence that discrimination is associated with poorer sleep outcomes. This evidence base can be strengthened with additional prospective studies that incorporate objectively measured aspects of sleep. We outline important extensions for this field of inquiry that can inform the development of interventions to improve sleep outcomes, and consequently promote well-being and reduce health inequities across the life course.

Section snippets

Methods

We conducted a systematic review of all English-language articles published in PubMed, Web of Science, and EBSCO databases (PsychInfo, ERIC, CINAHL) from 1971 through July 2014. Our search strategy was informed by prior literature reviews on discrimination and health [30], [32], [49]. Medical Subject Headings (MeSH) of the National Library of Medicine and keywords were used to search PubMed, and a similar search was designed for the EBSCO databases (see Appendix for sample search strategy). We

Description of included studies

Our database search identified 453 records; after excluding duplications (n = 96), 17 articles were selected for further evaluation, and two additional studies were identified from reference sections. A total of 17 articles met inclusion criteria for this review (see Fig. 1 for flow diagram). The characteristics of the selected studies are presented in Table 1. The earliest study on discrimination and sleep was published in 2003 [50]. Twelve of the 17 studies were cross-sectional, three were

Discussion

This systematic review displays consistent evidence that experiences of discrimination are associated with disordered sleep and objectively assessed sleep characteristics, although clarification is needed for nuanced aspects of this association. Although the majority of studies presented cross-sectional associations, three prospective studies and a natural experiment provide supporting evidence for the hypothesized temporal ordering [50], [51], [56], [62]. Among the studies using PSG- or

Funding sources

N Slopen and DR Williams received support from grant RO1 AG038492. TT Lewis received support from grant K01HL092591.

Conflict of interest

The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2015.01.012.

. ICMJE Form for Disclosure of Potential Conflicts of Interest form.

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