Racial/Ethnic Differences in Sleep Disturbances: The Multi-Ethnic Study of Atherosclerosis (MESA)

Abstract

Objectives: There is limited research on racial/ethnic variation in sleep disturbances. This study aimed to quantify the distributions of objectively measured sleep disordered breathing (SDB), short sleep duration, poor sleep quality, and self-reported sleep disturbances (e.g., insomnia) across racial/ethnic groups.

Design: Cross-sectional study.

Setting: Six US communities.

Participants: Racially/ethnically diverse men and women aged 54-93 y in the Multi-Ethnic Study of Atherosclerosis Sleep Cohort (n = 2,230).

Interventions: N/A.

Measurements and results: Information from polysomnography-measured SDB, actigraphy-measured sleep duration and quality, and self-reported daytime sleepiness were obtained between 2010 and 2013. Overall, 15.0% of individuals had severe SDB (apnea-hypopnea index [AHI] ≥ 30); 30.9% short sleep duration (< 6 h); 6.5% poor sleep quality (sleep efficiency < 85%); and 13.9% had daytime sleepiness. Compared with Whites, Blacks had higher odds of sleep apnea syndrome (AHI ≥ 5 plus sleepiness) (sex-, age-, and study site-adjusted odds ratio [OR] = 1.78, 95% confidence interval [CI]: 1.20, 2.63), short sleep (OR = 4.95, 95% CI: 3.56, 6.90), poor sleep quality (OR = 1.57, 95% CI: 1.00, 2.48), and daytime sleepiness (OR = 1.89, 95% CI: 1.38, 2.60). Hispanics and Chinese had higher odds of SDB and short sleep than Whites. Among non-obese individuals, Chinese had the highest odds of SDB compared to Whites. Only 7.4% to 16.2% of individuals with an AHI ≥ 15 reported a prior diagnosis of sleep apnea.

Conclusions: Sleep disturbances are prevalent among middle-aged and older adults, and vary by race/ethnicity, sex, and obesity status. The high prevalence of sleep disturbances and undiagnosed sleep apnea among racial/ethnic minorities may contribute to health disparities.

Keywords: apnea-hypopnea index; body mass index; daytime sleepiness; obesity; polysomnography; race/ethnicity; sleep disordered breathing; sleep disturbance; sleep duration; sleep quality.

Figure 1

Age-, study site-, and body mass index-adjusted logistic regression models for associations between race/ethnicity and sleep disturbances, stratified by sex: the Multi-Ethnic Study of Atherosclerosis (MESA), 2010–2013. (A) Sleep disordered breathing: apnea-hypopnea index (AHI) ≥ 15 (reference: AHI < 15). (B) Short sleep duration: < 6 h versus ≥ 6 h. (C) Poor sleep quality (sleep efficiency < 85% versus ≥ 85%). (D) Excessive daytime sleepiness (the Epworth Sleepiness Scale score > 10 versus score ≤ 10).

Figure 2

Sex-, study site-, and body mass index-adjusted logistic regression models for the associations between race/ethnicity and sleep disturbances, stratified by age groups: the Multi-Ethnic Study of Atherosclerosis (MESA), 2010–2013. (A) Sleep disordered breathing: apnea-hypopnea index (AHI) ≥ 15 (reference: AHI < 15). (B) Short sleep duration: < 6 h versus ≥ 6 h. (C) Poor sleep quality (sleep efficiency < 85% versus ≥ 85%). (D) Excessive daytime sleepiness (the Epworth Sleepiness Scale score > 10 versus score ≤ 10).

Figure 3

Sex-, age-, and study site-adjusted logistic regression models for the associations between race/ethnicity and sleep disturbances, stratified by body mass index (BMI): the Multi-Ethnic Study of Atherosclerosis (MESA), 2010–2013. (A) Sleep disordered breathing: apnea-hypopnea index (AHI) ≥ 15 (reference: AHI < 15). (B) Short sleep duration: < 6 h versus ≥ 6 h. (C) Poor sleep quality (sleep efficiency < 85% versus ≥ 85%). The Chinese group had no data for the obese group. (D) Excessive daytime sleepiness (the Epworth Sleepiness Scale score > 10 versus score ≤ 10). Normal weight: BMI < 25 kg/m²; Overweight: BMI = 25–29 kg/m². Obese: BMI ≥ 30 kg/m².