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Review
. 2023 Mar 1;19(3):605-620.
doi: 10.5664/jcsm.10336.

Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research

Dimitrios Papadopoulos  1 , Faustin Armel Etindele Sosso  2
Affiliations
Review

Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research

Dimitrios Papadopoulos et al. J Clin Sleep Med. .

Abstract

Study objectives: This review aims to assess the association between socioeconomic status (SES) and sleep health in the general population and the mediating effects of lifestyle and mental and physical health in this relationship.

Methods: Observational studies testing the independent association between objective or subjective SES indicators and behavioral/physiological or clinical sleep health variables in the general population were included. PubMed/MEDLINE was searched for reports published from January 1990 to December 2019. The direction of effect was used as the primary effect measure, testing the hypothesis that low SES is associated with poor sleep health outcomes. Results are presented in the form of direction effect plots and synthesized as binomial proportions.

Results: Overall, 336 studies were identified. A high proportion of effects at the expected direction was noted for measures of sleep continuity (100% for sleep latency, 50-100% for awakenings, 66.7-100% for sleep efficiency), symptoms of disturbed sleep (75-94.1% for insomnia, 66.7-100% for sleep-disordered breathing, 60-100% for hypersomnia), and general sleep satisfaction (62.5-100%), while the effect on sleep duration was inconsistent and depended on the specific SES variable (92.3% for subjective SES, 31.7% for employment status). Lifestyle habits, chronic illnesses, and psychological factors were identified as key mediators of the SES-sleep relationship.

Conclusions: Unhealthy behaviors, increased stress levels, and limited access to health care in low-SES individuals may explain the SES-sleep health gradient. However, the cross-sectional design of most studies and the high heterogeneity in employed measures of SES and sleep limit the quality of evidence. Further research is warranted due to important implications for health issues and policy changes.

Citation: Papadopoulos D, Etindele Sosso FA. Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research. J Clin Sleep Med. 2023;19(3):605-620.

Keywords: education; employment status; income; insomnia; sleep duration; sleep health; sleep quality; socioeconomic status.

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Conflict of interest statement

All authors have seen and approved the manuscript. Work for this study was performed at the Army Share Fund Hospital, Greece and the Redavi Institute, Canada. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Review flow diagram.
Figure 2
Figure 2. Heat map presentation for the synthesis of effects direction for the associations between each socioeconomic indicator and sleep outcome category.
Shades of green indicate a high proportion of expected direction of effects, shades of yellow an equal proportion of expected and opposite direction of effects, and shades of red a high proportion of opposite direction of effects. Values in bold indicate statistically significant proportions (P < .05) from the binomial test. CI = confidence interval, SES = socioeconomic status, WASO = wake after sleep onset.
Figure 3
Figure 3. Proposed pathways linking socioeconomic status and sleep outcomes.
The bidirectional arrows imply a possible reciprocal relationship between the two variables.
See this image and copyright information in PMC

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References

    1. Tobaldini E , Costantino G , Solbiati M , et al. . Sleep, sleep deprivation, autonomic nervous system and cardiovascular diseases . Neurosci Biobehav Rev. 2017. ; 74 ( Pt B ): 321 – 329 . - PubMed
    1. Chahine LM , Amara AW , Videnovic A . A systematic review of the literature on disorders of sleep and wakefulness in Parkinson’s disease from 2005 to 2015 . Sleep Med Rev. 2017. ; 35 : 33 – 50 . - PMC - PubMed
    1. Itani O , Jike M , Watanabe N , Kaneita Y . Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression . Sleep Med. 2017. ; 32 : 246 – 256 . - PubMed
    1. Kolla BP , He JP , Mansukhani MP , Frye MA , Merikangas K . Excessive sleepiness and associated symptoms in the U.S. adult population: prevalence, correlates, and comorbidity . Sleep Health. 2020. ; 6 ( 1 ): 79 – 87 . - PMC - PubMed
    1. Papadopoulos D , Sosso FAE , Khoury T , Surani SR . Sleep disturbances are mediators between socioeconomic status and health: a scoping review . Int J Ment Health Addict. 2020. ; 20 ( 1 ): 480 – 504 .