Sleep as a potential fundamental contributor to disparities in cardiovascular health

Abstract

Optimal sleep is integral to health but is commonly not obtained. Despite its wide-ranging public health impact, sleep health is considered only rarely by policy makers, employers, schools, and others whose policies and structures can adversely affect sleep. An inadequate duration of sleep and poor-quality sleep are prevalent in minority and low-income populations, and may be fundamental to racial and socioeconomic status inequities that contribute to a range of health conditions, including cardiovascular disease (CVD). This review examines the relationship between sleep and disparities in CVD. We describe the public health importance of sleep and the role of sleep duration, as well as the two most common disorders (sleep apnea and insomnia) as risk factors for a number of chronic diseases. We use a multilevel model focused on population health and health disparities, which is based on the notion that individual behaviors, such as sleep, are influenced by complex and dynamic interrelations among individuals and their physical and social environments. We also describe modifiable factors that contribute to insufficient sleep and circadian misalignment, propose potential interventions in various sectors (e.g., neighborhoods, schools, workplaces) that can address social structures that contribute to disparities, and recommend areas for future research. Integrating sleep into public health research will identify novel approaches for closing gaps in health disparities.

Keywords: cardiovascular disease; ethnicity; health disparities; race.

Figure 1

Forest plots of the risk of developing or dying of coronary heart disease associated with (A) short duration of sleep compared with the reference group and (B) long duration of sleep compared with the reference group. (29)

Figure 2

The Socioecological Model and Determinants of Sleep and Cardiovascular Health