Daylight saving time debate sheds light on growing racial disparities in sleep health



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As the United States turned the clocks back an hour this month end of daylight saving timeMany people got a little more sleep than usual – but some not as much as others.

Growing evidence suggests that sleep deprivation and sleep disorders, such as obstructive sleep apnea, are more prevalent in Black, Asian, and Hispanic or Latino communities, and these disparities can have long-term detrimental effects on physical health, even That risk may also increase. some chronic diseases.

Meanwhile, daylight saving time itself – enacted in the US to reduce electricity use by increasing daylight hours – has long been controversial in the United States.

The American Academy of Sleep Medicine, the Sleep Research Society, and other medical groups have advocated for an end to this practice, calling for the adoption of a permanent standard time that would not involve moving forward each spring and turning back each autumn. .

Professor of neurology and pediatrics and director of the Vanderbilt University Medical Center Sleep Division in Nashville, Dr. “Daylight saving time is associated with increased risks of sleep deprivation, circadian misalignment and adverse health outcomes,” Beth Malo said in a news release. this month. They wrote a paper published in September in the journal Sleep, detailing the potential health benefits of adopting a permanent standard time.

In March, the US Senate unanimously passed the Sunshine Protection Act, which would make daylight saving time permanent across the country — meaning there would be no return to “standard time” from early November to mid-March — but the law must pass the House and receive President Joe Biden’s signature before it can take effect in November 2023.

Now, some sleep researchers worry about the potential effects that changing standard time twice each year could have on sleep health disparities.

“Poor sleep is associated with a number of poor health outcomes, including obesity, high blood pressure, type 2 diabetes, cardiovascular disease, and certain cancers, including breast and colon. Many of these health outcomes are more prevalent in black populations,” notes the National Institute of Environmental Health Sciences. said Chandra Jackson, a researcher and epidemiologist in the U.S. who is studying racial and ethnic disparities in sleep.

“Experimental as well as observational studies have linked sleep to these health outcomes. Therefore, sleep may be an important contributor,” she said. “Fortunately, sleep health is largely modifiable.”

As for the observed disparities in sleep health, it is not that white adults do not also experience lack of sleep and its health consequences – but people of color experience them disproportionately more, and it is believed that This is largely due to the social systems in the United States.

Sleep allows the body to restore itself at the cellular level. According to the National Institutes of Health, during sound sleep, your heart rate, blood pressure and breathing can rise and fall, which may be important for heart health, and your body releases hormones that help repair cells and use energy. helps to control. These hormone changes can also affect your weight.

A study published in October in the journal PLOS Medicine suggests that people age 50 and older who sleep five hours or less a night have a higher risk of several chronic diseases than their peers. Are older, who get a good night’s rest.

Separate research published in October in the Journal of the American Heart Association suggests that cardiovascular health guidelines are more effective at predicting a person’s risk of heart disease if they include sleep — and focus only on diet and exercise. Don’t do it.

Certain physiological processes – such as immune function, heart health and memory formation – require certain amounts of sleep. Without adequate sleep, the body and brain may not function optimally, said Dr. Cesar Carabello-Cordovez, a postdoctoral associate at the Center for Outcomes Research and Evaluation at Yale, who has studied racial and ethnic disparities in sleep duration. .

“Short sleep duration has been associated with a higher risk of adverse medical events and conditions, including diabetes, obesity, high blood pressure, heart disease, impaired cognitive function, and death,” Caraballo-Córdovez wrote in an email. Adults need at least seven hours of sleep per day.

According to recent research by Carabello-Cordovez, Jackson and colleagues, racial and ethnic disparities in sleep duration are getting worse across the United States. Their study, published in April in the medical journal JAMA Network Open, found that among more than 400,000 adults in the US between 2004 and 2018, short and long sleep duration were consistently higher among those who were black and Hispanic or Latino. , Short sleep is less than seven hours a day and long sleep is more than nine hours.

Although there was a significant increase in the prevalence of insufficient sleep among all groups during the study period, the prevalence of short sleep increased by 6.39 and 6.61 percentage points among black and Hispanic or Latino adults, respectively, compared to 3.22 percentage points among whites. .

Caraballo-Córdovez said many of the social and environmental factors that can disrupt sleep are more common in the US among people who are black and Hispanic or Latino.

“These include housing conditions, noise pollution, light pollution, air pollution, stress from various sources – including perceived racial discrimination – and job or working conditions,” he said, adding that the convergence of all those factors may explain this. That’s why the recommended amount of sleep “may be less common in black adults than in white adults.”

Both Carabello-Cordovez and Jackson emphasize that more research is needed on the reasons behind the racial sleep disparity.

Many social and environmental determinants of health—including living conditions or work schedules that do not support sleep—may emerge, at least in part, from historical and persistent forms of structural racism, which Jackson describes as “those in societies.” as a totality of methods”. Perpetuating racial discrimination through mutually reinforcing systems of housing, education, employment, wages, benefits, credit, the media, health care, and criminal justice.

Jackson said she often reflects on how the death of Breonna Taylor in Louisville in March 2020 and the shooting of George Floyd’s 4-year-old granddaughter in Houston on New Year’s Day while they were sleeping — and how structural racism The system can develop conditions in America that make such incidents more likely to occur in Black communities. “It will require research,” she said.

Examples of structural racism and how they can impact health include discriminatory mortgage lending and appraisals in the US, which affect the conditions in which people of color can live; predominantly white school districts receive more funding than districts serving people of color, affecting the quality of education some people of color can receive; and even how hair discrimination may contribute to some black women using potentially harmful chemical hair products because policies may not allow specific hairstyles at school or in the workplace.

“These policies and practices may lead to disparities in the promotion of health or harm resources across racial groups, and in turn reinforce discriminatory beliefs,” Jackson said. “That is, it recognizes that discriminatory policies and practices in all sectors of society create physical and social conditions that make it more difficult for Black families to get optimal sleep and be healthy. Fortunately, these Policies and practices are also changeable.”

Although more research is needed on the reasons for the disparities in sleep, she said, essentially anything that causes physical and psychological stress is a threat to sleep health, and these stressors are more prevalent in black communities.

In the US Department of Health and Human Services’ Healthy People 2030 Plan for a Nation, improving health by helping people get enough sleep was listed as a goal, including increasing the proportion of adults with symptoms of sleep apnea. Objectives including being evaluated by a health care. Increasing the proportion of providers and schools starting later in the morning. Improving sleep health has been a national objective in the federal government’s last two Healthy People programs, noted Carabello-Córdovez, who is not involved in the programs.

But they added that “the impact of strategies focused on improving sleep knowledge and habits — although important and necessary — may be limited if they do not address the persistent barriers that prevent Black individuals from achieving and maintaining healthy lives.” ”

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