A Q&A With the NIEHS’ Dr Symielle Gaston: Understanding Racial/Ethnic Variations in Sleep Health

Symielle A. Gaston, PhD, MPH, is staff scientist within the Social & Environmental Determinants of Health Equity Group of the National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health. During SLEEP 2023, she presented on how racial and ethnic residential segregation affect sleep health disparities, with the principal conclusion of her analysis being that neighborhood-level poverty and structural racism may be to blame for these disparities.

In this interview with The American Journal of Managed Care®, she explores the relationship between sleep health and outcomes disparities among patients of various races and ethnicities.

This transcript has been lightly edited for clarity and conciseness.

AJMC: What are some common factors that contribute to individual variation in sleep patterns, and how do they affect overall health and well-being?

Gaston: Although sleep varies by individual-level characteristics such as age, sex, gender, race, and ethnicity, it is important to consider environmental features and hazards that can affect sleep patterns in populations. For example, neighborhood characteristics such as neighborhood social cohesion, or the connectedness between neighbors, have been associated with sleep health. By impacting sleep, these exposures can directly and indirectly impact myriad health and well-being outcomes, including infectious and chronic diseases as well as mental health and well-being.^1,2

AJMC: Can you explain potential differences in sleep disorders/patterns among patients of various races and ethnicities, not only in prevalence but in how symptoms manifest and why these variances exist?

Gaston: There are known persistent racial/ethnic disparities in sleep health, with Black/African Americans being much more likely to have insufficient sleep and poor sleep quality compared with non-Hispanic White Americans. There is less literature about sleep disparities among other minoritized racial and ethnic groups, too; however, data consistently suggest poorer sleep health among certain Latino/a/e/x populations, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander groups as well. All causes are not well understood; however, structural racism is considered a fundamental cause of sleep health disparities since it manifests as differential access to sleep health–promoting resources by race and ethnicity.³

AJMC: What role do social determinants of health (SDOH) and work and home environments play in the presentation of sleep disorders, and from your research, what factors (food insecurity, housing insecurity, lack of access to health care, etc) exert the most influence?

Gaston: All SDOH, including economic stability, access to and quality of education, access to and quality of health care, neighborhood and built environment, and the social community context have an impact on sleep health and shape sleep health disparities. Currently, it is difficult to determine which factors exert the most influence, which supports the need for continued research utilizing exposomic approaches that capture the totality and complexity of interactions between environmental exposures and biological factors over the life course.⁴

AJMC: How do racial/ethnic segregation and structural racism contribute to sleep health disparities, and how might neighborhood-level poverty exacerbate differences in outcomes?

Gaston: Structural racism manifests as mutually reinforcing inequitable systems that influence discriminatory practices, including inequitable distribution of resources by race and ethnicity. Racial/ethnic segregation is one component of structural racism that separates minoritized racial/ethnic groups from non-Hispanic White people. Moreover, it contributes to disinvestment and inequitable access to economic opportunities in neighborhoods disproportionately comprised of minoritized racial/ethnic groups.

These areas of concentrated disadvantage often are disproportionately burdened by environmental hazards that are known sleep disruptors, including inopportune light exposure, noise, poor air quality, and temperature extremes (eg, urban heat). Therefore, high neighborhood-level poverty may exacerbate sleep health disparities among minoritized racial/ethnic groups in highly segregated neighborhoods due to disadvantages related to isolation from sleep-promoting resources and disproportionate exposure burdens to known sleep disruptors.

AJMC: Can you discuss the overall importance of studying sleep health in minority populations, as well as among those traditionally underrepresented in sleep health studies?

Gaston: To improve sleep health for all, all populations must be included in studies. If minoritized and underrepresented groups are not included, we are perpetuating systemic structural racism.

AJMC: For sleep research moving forward, what are some priorities in minority populations?

Gaston: Priorities include moving toward more culturally relevant intervention studies. The existence of sleep disparities is now well documented; therefore, priorities include designing, implementing, and evaluating interventions with the goal of mitigating health disparities.

AJMC: Based on your expertise, what evidence-based interventions or recommendations would you propose to optimize sleep quality and establish a consistent and healthy sleep regimen?

Gaston: Interventions at the macro and micro levels could address sleep health disparities. Research supports cognitive behavioral therapy, yoga, mindfulness, and promotion of healthy sleep behaviors (eg, going to bed in a dark, quiet, cool/comfortable room) as effective intervention strategies for individuals. Yet, it will also be important to investigate how optimizing environments that are often beyond individual-level control (eg, neighborhoods) can mitigate sleep health disparities. This may include strategies related to economic development in marginalized communities, improving neighborhood safety, reducing noise, and mitigating other environmental hazards in neighborhood and home environments.

References

1. Watson NF, Badr MS, Belenky G, et al; Consensus Conference Panel. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. Sleep. 2015;38(8):1161-1183. doi:10.5665/sleep.4886

2. Alhasan DM, Gaston SA, Jackson WB 2nd, Williams PC, Kawachi I, Jackson CL. Neighborhood social cohesion and sleep health by age, sex/gender, and race/ethnicity in the United States. Int J Environ Res Public Health. 2020;17(24):9475. doi:10.3390/ijerph17249475

3. Johnson DA, Jackson CL, Williams NJ, Alcántara C. Are sleep patterns influenced by race/ethnicity - a marker of relative advantage or disadvantage? evidence to date. Nat Sci Sleep. 2019;11:79-95. doi:10.2147/NSS.S169312

4. Alhasan DM, Gaston SA, Jackson CL. Investigate the complexities of environmental determinants of sleep health disparities. Sleep. 2022 Aug 11;45(8):zsac145. doi:10.1093/sleep/zsac145