Racial/Ethnic and Social Inequities in Sleep Medicine: The Tip of the Iceberg?

Purpose

It is known that racial disparities exist in terms of disease prevalence and access to health care. However, the link between race/ethnicity and sleep quality is often under-recognized.

Is Poor Sleep Quality Associated With Greater Disability in Patients With Multiple Sclerosis?

Poor sleep is a serious burden for patients with multiple sclerosis (MS). The aim of this study is to assess whether the association between sleep quality and disability in MS patients is direct or mediated by depression, pain, and fatigue. We collected data from 152 patients with MS who filled out the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, the Multidimensional Fatigue Inventory and one item of the Short Form-36 regarding pain. The relationship between poor sleep and disability was found to be indirect, mediated by depression (p < 0.05), pain (p < 0.001) and physical fatigue (p < 0.01). Treatment of sleep disturbances may have beneficial effects beyond improving sleep. It may reduce depression, pain, and physical fatigue, which in turn may lessen disability.     

Is Skin Color a Marker for Racial Discrimination? Explaining the Skin Color–Hypertension Relationship

It is widely assumed that dark-skinned Blacks have higher rates of hypertension than their lighter-skinned cohorts because the former experience greater racial discrimination. However, there is no empirical evidence linking skin color to discrimination. This study tested the extent to which skin color is associated with differential exposure to discrimination for a sample of 300 Black adults. Results revealed that dark-skinned Blacks were 11 times more likely to experience frequent racial discrimination than their light-skinned counterparts; 67% of subjects reporting high discrimination were dark-skinned and only 8.5% were light-skinned. These preliminary findings suggest that skin color indeed may be a marker for racial discrimination and highlight the need to assess discrimination in studies of the skin color–hypertension relationship.     

Sleep Duration and Obesity in Children: Is the Association Dependent on Age and Choice of the Outcome Parameter?

Study Objectives:

To assess the association between sleep duration in children and different markers of body fat by age and weight status.

Design:

Nation-wide health survey. Measurement of BMI and body fat percentage (KFA) calculated from weight, height, skin fold thickness, age, and sex. Sleep duration and potential confounding variables were assessed in a parent questionnaire.

Setting:

N/A

Participants:

7767 German resident children from 3 to 10 years of age.

Interventions:

N/A

Measurements and Results:

Prolongation of sleep duration from the lowest to the highest percentile accounted for a similar mean decrease in BMI (−0.235, 95%-CI −0.321; −0.149) and KFA (−0.182, 95% CI −0.271; −0.092) z-scores. The given association is adjusted for confounding variables and did not show a systematic age dependency. The greatest effects of sleep duration were seen for the upper tails of the BMI and KFA distributions, which were about four as high as the lower tails.

Conclusions:

The association between sleep duration and weight status is of similar size through ages 3 to 10 years. The sleep-associated changes in BMI are likely to be a consequence of higher body fat and primarily affect children whose BMI or KFA is already elevated. These findings favor hormonal pathways nurturing adipose tissue playing a key role in the underlying physiological mechanisms.

Citation:

Bayer O; Rosario AS; Wabitsch M; von Kries R. Sleep duration and obesity in children: is the association dependent on age and choice of the outcome parameter? SLEEP 2009;32(9):1183-1189.     

Is There a Color Line in Death?: An Examination of End-of-Life Care in the African American Community

Although the goals of end-of-life care and hospice are to mitigate suffering and improve quality of life for patients with terminal illnesses, they remain underutilized by a significant number of African Americans. While sociocultural issues play a role in the underutilization of these resources among African Americans, other confounding factors affect the ability of African Americans to adequately access quality care at the end of life. Here, the authors examine the various barriers preventing increased use of hospice care and palliative therapy among African Americans. A particular focus of this examination will revolve around suggestions for increasing the use of end-of-life care among African Americans in the future.     

Racial and ethnic harassment and discrimination: in the eye of the beholder?

The nature, rate, and higher-order relationships among facets of racial/ethnic harassment (REH) and discrimination (RED) were examined across five racial/ethnic groups in a sample of 5,000 US military personnel. Using a hierarchical, multigroup confirmatory factor analysis approach, results suggest that the nature of REH and RED do not differ by race, with behavioral items equally representing REH and RED across the different groups. Further, higher-order relationships among the facets of REH and RED do not vary across race, with a single second-order factor accounting for the relationships. This single factor is theorized to represent a root intergroup prejudice that leads to harassment and discrimination. However, as anticipated, individuals from minority groups generally reported higher levels of REH and RED once measurement equivalence has been established. Together, the results suggest that both intergroup prejudice (which is multidirectional) and racism (which originates in powerful groups against other groups) are operating in REH and RED experiences.     

Immigration and Sleep Problems in a Southern European Country: Do Immigrants Get the Best Sleep?

This study analyzes the differences in the prevalence of insomnia symptoms and nonrestorative sleep (NRS) between people born in Spain and immigrants from 7 countries with most immigrants in Spain. Data come from the 2006 Spanish National Health Survey. The sample was composed of all individuals aged 16 to 64 years from Spain and the 7 countries with most immigrants in Spain (N = 22,224). In both sexes, people from Bolivia had a higher prevalence of insomnia symptoms and NRS. Conversely, people from Ecuador, Morocco, and Romania had less insomnia symptoms and NRS than Spanish-born participants. No differences were found between Spanish-born participants and Colombian, Peruvian, and Argentinian women. Poor living conditions in the country of origin and in the host country, discrimination, and culturally related lifestyles could be related to poorer sleep health among Bolivian men. Acculturation may explain the similar sleep health patterns noted between Spanish-born participants and long-term immigrants.     

HIV testing rates among African Americans: why are they not increasing?

HIV/AIDS disproportionately affects the African-American community. It is imperative to increase the awareness of HIV/AIDS as well as the amount of people getting tested. Sometimes strategies to increase testing in the African-American community do not have to do with access but more so with other circumstances surrounding testing. These include fear of needles, being discriminated against if HIV-positive, perception of low risk, and long waiting periods for results. It is important to consider that all of these factors have an effect on peoples' decision to be tested for HIV/AIDS when offering testing.     

Low birth weight of contemporary African Americans: An intergenerational effect of slavery?

The average birth weight in the contemporary African‐American population is about 250 g lower than the average birth weight of European Americans. Differences in genetic and socioeconomic factors present between these two groups can explain only part of birth weight variation. I propose a hypothesis that the low birth weight of contemporary African Americans not only results from the difference in present exposure to lifestyle factors known to affect fetal development but also from conditions experienced during the period of slavery. Slaves had poor nutritional status during all stages of life because of the inadequate dietary intake accompanied by high energetic costs of physical work and infectious diseases. The concept of “fetal programming” suggests that physiology and metabolism including growth and fat accumulation of the developing fetus, and, thus its birth weight, depend on intergenerational signal of environmental quality passed through generations of matrilinear ancestors. I suggest that several generations that have passed since the abolition of slavery in the United States (1865) has not been enough to obliterate the impact of slavery on the current biological and health condition of the African‐American population. Am. J. Hum. Biol., 2009. © 2008 Wiley‐Liss, Inc.     

Tocilizumab in COVID-19: Is the Temptation Worthwhile?

How to cite this article: Gupta S, Tomar DS. Tocilizumab in COVID-19: Is the Temptation Worthwhile? Indian J Crit Care Med 2021;25(3): 247–248.     

Sleep in Children With Autism Spectrum Disorders: How Are Measures of Parent Report and Actigraphy Related and Affected by Sleep Education?

Sleep disturbance is common in children with autism, resulting in a great need for effective treatments. To evaluate treatments for sleep disturbance in this population, it is critical to understand the relationship between measures of sleep captured by parent report and objective measures. The Children’s Sleep Habits Questionnaire (CSHQ) and actigraphy-measured data from 80 children with autism and sleep-onset delay were evaluated. Reported problems with sleep-onset delay were concurrent with sleep duration problems in 66% of children, night wakings in 72% of children, and bedtime resistance in 66% of children; 38% of children were reported to have problems with all CSHQ insomnia domains. Actigraphy-measured sleep duration was correlated with estimates using CSHQ-reported bed and wake times.