Sleep disorders in African Americans and Caucasian Americans: a meta-analysis
Abstract
Previous research suggests that ethnic groups differ in the prevalence and severity of disordered sleep symptoms. This study used meta-analysis to determine the magnitude of ethnic differences between African Americans (AAs) and Caucasian Americans (CAs) in insomnia symptoms and sleep-disordered breathing (SDB). It also used moderator analyses to explore the variability in these effect sizes. Thirteen studies measuring insomnia symptoms and 10 studies measuring SDB met inclusion criteria and represented thousands of adult AAs and CAs. Results indicate AAs have a higher prevalence and greater severity of SDB, but CAs report more insomnia symptoms. These results indicate a need for a multi-ethnic approach to the assessment and treatment of sleep disorders.
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African-Americans were more likely to have sleep disordered breathing, of greater severity, compared to Whites.
“Regarding sleep disorders, Ruiter and colleagues(226) found that African-Americans were more likely to have sleep disordered breathing, of greater severity, compared to Whites.”
From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [226]
Sleep disorders such as obstructive sleep apnea may be more common, go undiagnosed more frequently and may be treated less efficaciously in African American patients.
“sleep disorders such as obstructive sleep apnea (OSA) may be more common, go undiagnosed more frequently and may be treated less efficaciously in African American patients [18, 19]”
From Association between sleep deficiency and cardiometabolic disease: implications for health disparities (2016) · cites this paper as [18]
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Bulls, H. W., Lynch, M. K., Petrov, M. E. R., Gossett, E. W., Owens, M. A., Terry, S. C., Wesson-Sides, K. M., & Goodin, B. R. (2017) · Annals of Behavioral Medicine · doi:10.1007/s12160-017-9889-x · Cited by 25 · see citing works
Socioeconomic status in childhood predicts sleep continuity in adult Black and White men
Matthews, K. A., Jennings, J. R., & Lee, L. (2017) · Sleep Health · doi:10.1016/j.sleh.2017.09.008 · Cited by 25 · see citing works
Vargas, I., Egeler, M. E., Walker, J. L., & Benitez, D. E. D. (2023) · Frontiers in Sleep · doi:10.3389/frsle.2023.1279903 · Cited by 23 · see citing works
“…do now support that BIPOC populations, especially those individuals who identify as Black or African American, are at greater risk for experiencing insomnia symptoms and insomnia disorder (Ruiter et al., 2010; Grandner et al., 2013; Chen et al., 2015; Kalmbach et al., 2016; Cheng et al., 2021).”
Sleep health challenges among women: insomnia across the lifespan
Benge, E., Pavlova, M. K., & Javaheri, S. (2024) · Frontiers in Sleep · doi:10.3389/frsle.2024.1322761 · Cited by 22 · see citing works
Lichstein, K. L., Taylor, D. J., McCrae, C. S., & Petrov, M. E. R. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-24288-2.00081-7 · Cited by 21 · see citing works
Self-citationWallace, D. M., & Wohlgemuth, W. K. (2014) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.4106 · Cited by 22 · see citing works
“6 23-25 The aims of this study were (1) to examine whether race-eth-nic differences exist in functional outcomes of sleep between blacks and whites with OSAS treated with CPAP, and (2) to determine whether race-ethnicity moderates the relationship between treatment adherence and functional outcomes…”
InfluentialWHITESELL, P. L., Obi, J., Tamanna, N., & Sumner, A. E. (2018) · Frontiers in Endocrinology · doi:10.3389/fendo.2018.00140 · Cited by 21 · see citing works
Causadias, J. M., Korous, K. M., & Cahill, K. M. (2018) · Development and Psychopathology · doi:10.1017/s0954579418000895 · Cited by 19 · see citing works
Obstructive sleep apnea and stroke: links to health disparities
Ramos, A. R., Seixas, A. A., & Dib, S. I. (2015) · Sleep Health · doi:10.1016/j.sleh.2015.09.005 · Cited by 21 · see citing works
Self-Reported Sleep in Older African Americans and White Americans
Turner, A. D., Lim, A. S. P., Leurgans, S. E., Bennett, D. A., Buchman, A. S., & Barnes, L. L. (2016) · Ethnicity & Disease · doi:10.18865/ed.26.4.521 · Cited by 21 · see citing works
No Rest for the Wicked? The Consequences of Incarceration for Sleep Problems
Testa, A. M., & Porter, L. C. (2017) · Society and Mental Health · doi:10.1177/2156869317707002 · Cited by 22 · see citing works
“Additionally, incarceration disproportionality impacts racial minorities (Travis et al. 2014), and sleep problems tend to be unequally distributed across the population (Chen et al. 2015; Hale and Do 2007; Lauderdale et al. 2006; Ruiter et al. 2010, 2011).”
BackgroundEl-Solh, A., O'Brien, N., Akinnusi, M. E., Patel, S. K., Vanguru, L., & Wijewardena, C. (2019) · Sleep And Breathing · doi:10.1007/s11325-019-01840-4 · Cited by 22 · see citing works
“In particular, studies indicate shorter sleep duration, poorer sleep efficiency, greater onset latency, and worse overall sleep quality among AAs relative to Whites [26, 28].”
BackgroundMegwalu, U. C., Raol, N., Bergmark, R. W., Osazuwa‐Peters, N., & Brenner, M. J. (2022) · Otolaryngology · doi:10.1177/01945998221087138 · Cited by 22 · see citing works
“For example, Black individuals have a higher prevalence and greater severity of sleep-disordered breathing as compared with non-Hispanic White individuals.(6) Medical outcomes of disease can also vary by population groups, as exemplified by the higher complication rates observed in racial minority patients undergoing…”
BackgroundRacial disparity in sleep apnea-related mortality in the United States
Lee, Y.-C., Chang, K.-Y., & Mador, M. J. (2022) · Sleep Medicine · doi:10.1016/j.sleep.2021.11.014 · Cited by 20 · see citing works
Sleep, Sleepiness, and Sleep Disorders: Principles for Examining Differences by Ethnicity
Paine, S., & Gander, P. H. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-378610-4.00526-x · Cited by 20 · see citing works
Epidemiology of Bedtime, Arising Time, and Time in Bed: Analysis of Age, Gender, and Ethnicity
Thomas, S. J., Lichstein, K. L., Taylor, D. J., Riedel, B. W., & Bush, A. J. (2013) · Behavioral Sleep Medicine · doi:10.1080/15402002.2013.778202 · Cited by 18 · see citing works
“Furthermore, the types of sleep complaints may reflect sleep disorder differences between African Americans and Caucasians, as Caucasians have a higher prevalence of insomnia and African Americans have a higher prevalence of sleep-disordered breathing (Ruiter et al., 2010).”
BackgroundSelf-citationFausto, B. A., Azimipour, S., Charles, L., Yarborough, C. C., Grullon, K., Hokett, E., Duberstein, P. R., & Gluck, M. A. (2021) · Journal of Applied Gerontology · doi:10.1177/07334648211010580 · Cited by 17 · see citing works
“…reasons for these health disparities are unknown, several health conditions, such as sleep deficiencies and obesity, are also more prevalent among African Americans and have been independently linked to cognitive and mood dysfunction (Ruiter et al., 2010; E. Smith et al., 2011; Tsuno et al., 2005).”
Semenova, N. V., Михайловна, М. И., Bairova, T. A., Zhambalova, R. M., Sholokhov, L. F., & Колесникова, Л. И. (2018) · Chronobiology International · doi:10.1080/07420528.2018.1456447 · Cited by 17 · see citing works
“…have shown a greater prevalence of insomnia in Caucasian (Chapman et al. 2011; Grandner et al. 2013; Jean-Louis et al. 2007; Riedel et al. 2004; Ruiter et al. 2010), and according to other sources insomnia is more often observed in representatives of the Negroid race (Bixler et al. 2002;…”
BackgroundDisturbed Sleep as a Mechanism of Race Differences in Nocturnal Blood Pressure Non-Dipping
Bowman, M. A., Buysse, D. J., Foust, J. E., Oyefusi, V., & Hall, M. H. (2019) · Current Hypertension Reports · doi:10.1007/s11906-019-0954-7 · Cited by 17 · see citing works
Quintos, A., Naranjo, M., Kelly, C., Quan, S. F., & Sharma, S. (2019) · Journal of the National Medical Association · doi:10.1016/j.jnma.2018.09.003 · Cited by 16 · see citing works
Genetic Ancestry for Sleep Research
Prasad, B., Saxena, R., Goel, N., & Patel, S. R. (2018) · CHEST Journal · doi:10.1016/j.chest.2018.03.024 · Cited by 15 · see citing works
Severity of Obstructive Sleep Apnea Between Black and White Patients
Alkhazna, A. A., Bhat, A., Ladesich, J. B., Barthel, B., & Bohnam, A. (2011) · Hospital Practice · doi:10.3810/hp.2011.10.926 · Cited by 15 · see citing works
“cated a higher prevalence and greater severity of sleep-disordered breathing in black patients than white patients.(10) However, insuffi cient data were available to calculate D ow nl oa de d by [ Y or k U ni ve rs ity L ib ra ri es ] at 0 2: 42 0 6 N ov em be r 20 15”
BackgroundKhan, M. S., Stone, A., Soose, R. J., Cohen, S. M., Howard, J. J. M., Capasso, R., Itayem, D. A., Gillespie, M. B., Mehra, R., Chio, E. G., et al. (2022) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.10068 · Cited by 14 · see citing works
Racial differences in upper airway collapsibility and loop gain in young adult males
Puri, S., Panza, G. S., Kissane, D. M., Jones, S., Reck, K., Lin, H., Badr, M. S., & Mateika, J. H. (2023) · SLEEP · doi:10.1093/sleep/zsad091 · Cited by 13 · see citing works
“In regard to race, limited published data exploring differences in sleep apnea severity in Black compared to White participants has been equivocal [6–9].”
BackgroundMoving Beyond Detection: Charting a Path to Eliminate Health Care Disparities in Otolaryngology
Bowe, S. N., Megwalu, U. C., Bergmark, R. W., & Balakrishnan, K. (2022) · Otolaryngology · doi:10.1177/01945998221094460 · Cited by 13 · see citing works
“For example, African Americans have a higher prevalence and greater severity of sleep-disordered breathing than nonHispanic White individuals.(16) However, Black children with sleep-disordered breathing are less likely to undergo adenotonsillectomy than other non-Hispanic White children.”
BackgroundPrevalence of Obstructive Sleep Apnea Among Veterans and Nonveterans
Goldstein, L. A., Bernhard, P. A., Hoffmire, C. A., Schneiderman, A., & Maguen, S. (2024) · American Journal of Health Promotion · doi:10.1177/08901171241273443 · Cited by 12 · see citing works
“18,39 Some research has highlighted potential barriers to testing in Blacks, including healthcare avoidance and anxiety about physiological testing procedures, which could be a potential intervention point for education and care delivery.”
Race, socioeconomic position and sleep
Williams, N., Jean-Louis, G., Blanc, J., & Wallace, D. (2019) · Sleep and Health · doi:10.1016/b978-0-12-815373-4.00006-x · Cited by 9 · see citing works
Examining the diagnostic validity of the Berlin Questionnaire in a low-income Black American sample
Holliday, S. B., Haas, A. C., Dong, L., Ghosh‐Dastidar, M., Hale, L. E., Buysse, D. J., Dubowitz, T., & Troxel, W. (2021) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.9388 · Cited by 12 · see citing works
Racial Disparities in Surgical Treatment of Obstructive Sleep Apnea
Cohen, S. M., Howard, J. J. M., Jin, M. C., Qian, Z. J., & Capasso, R. (2022) · OTO Open · doi:10.1177/2473974x221088870 · Cited by 12 · see citing works
Andreozzi, F., Overstraeten, C. V., Youssef, S. B., Bold, I., Carlier, S., Gruwez, A., André, S., Bruyneel, A.-V., & Bruyneel, M. (2019) · Sleep And Breathing · doi:10.1007/s11325-019-01912-5 · Cited by 12 · see citing works
Estructura factorial y consistencia interna de la escala de somnolencia de Epworth
Pedrozo‐Pupo, J. C., Córdoba, A. P., & Campo‐Arias, A. (2020) · Revista de la Facultad de Medicina · doi:10.15446/revfacmed.v68n2.73025 · Cited by 11 · see citing works
Discrimination and sleep among Asians and Pacific Islanders adults
Ogbenna, B. T., Ryu, S., Lee, S., & Slopen, N. B. (2021) · SLEEP · doi:10.1093/sleep/zsab109 · Cited by 12 · see citing works
Burden of sleep disturbance in non-Hispanic Black pregnant women
White, K. M., Dunietz, G. L., Pitts, D., Kalmbach, D. A., Lucchini, M., & O'Brien, L. M. (2021) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.9854 · Cited by 11 · see citing works
Groeger, J. A., & Hepsomali, P. (2023) · Clocks & Sleep · doi:10.3390/clockssleep5030030 · Cited by 11 · see citing works
“While US studies consistently report that Black/African Americans have more sleep challenges than their White counterparts (see meta-analyses [20,21], such conclusions can obscure the complexity of the issues involved.”
BackgroundWilliams, N. J., Jean‐Louis, G., Ceïde, M. E., Pandey, A., Osorio, R. S., Mittelman, M. S., & McFarlane, S. I. (2017) · Journal of Sleep Disorders & Therapy · doi:10.4172/2167-0277.1000269 · Cited by 10 · see citing works
Factores de riesgo y asociados al síndrome de apnea-hipopnea obstructiva del sueño (SAHOS)
Páez-Moya, S., & Vega-Osorio, P. A. (2017) · Revista de la Facultad de Medicina · doi:10.15446/revfacmed.v65n1sup.59646 · Cited by 9 · see citing works
Obstructive Sleep Apnea and Alzheimer’s Disease Pathology: Is Sleep Architecture the Missing Key?
Gills, J. L., & Bubu, O. M. (2024) · Journal of Alzheimer s Disease · doi:10.3233/jad-231385 · Cited by 9 · see citing works
(2022) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9780890425787.x12_sleep-wake_disorders · Cited by 8 · see citing works
Utilization of surgical treatment for sleep apnea: A study of health disparities
Ruthberg, J. S., Summerville, L., Cai, Y., Boas, S. R., Otteson, T. D., & Kumar, A. (2020) · American Journal of Otolaryngology · doi:10.1016/j.amjoto.2020.102670 · Cited by 8 · see citing works
Classification and Epidemiology of Sleep Disorders in Children and Adolescents
Trosman, I., & Ivanenko, A. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2023.06.004 · Cited by 7 · see citing works
Patient-Centered Clinical Care for African Americans
Hall, G. L. (2019) · Springer eBooks · doi:10.1007/978-3-030-26418-5 · Cited by 6 · see citing works
Fausto, B. A., & Gluck, M. A. (2020) · Ethnicity and Health · doi:10.1080/13557858.2020.1821176 · Cited by 6 · see citing works
Effects of modafinil on electroencephalographic microstates in healthy adults
Linton, S. R., Murphy, M., Schroder, H. S., Breiger, M., Iturra-Mena, A. M., Kangas, B. D., Bergman, J., Carlezon, W. A., Risbrough, V. B., Barnes, S. A., et al. (2022) · Psychopharmacology · doi:10.1007/s00213-022-06149-x · Cited by 6 · see citing works
“Past research suggests Black adults are more likely to develop sleep apnea and experience a higher prevalence and greater severity of sleep-disordered breathing compared to White adults (Chen et al. 2015; Ruiter et al. 2010).”
BackgroundSleep Apnea and Incident Stroke in a National Cohort of Black and White Adults
Robbins, R., Yuan, Y., Johnson, D. A., Long, D. L., Molano, J. R. V., Kleindorfer, D., Petrov, M. E. R., & Howard, V. J. (2024) · Neurology · doi:10.1212/wnl.0000000000209171 · Cited by 6 · see citing works
Tchio, C. I. M., Musani, S. K., Quarshie, A., & Tosini, G. (2021) · BMC Medical Genomics · doi:10.1186/s12920-021-00983-2 · Cited by 6 · see citing works
Preoperative obstructive sleep apnea screening in gynecologic oncology patients
Harrison, R. F., Medlin, E. E., Petersen, C. B., Rose, S. L., Hartenbach, E. M., Kushner, D. M., Spencer, R. J., Rice, L. W., & Al‐Niaimi, A. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2018.05.012 · Cited by 6 · see citing works
Billings, M. E., Rosen, C. L., Wang, R., Auckley, D., Benca, R., Foldvary-Schaefer, N., Iber, C., Zee, P., Redline, S., & Kapur, V. K. (2013) · SLEEP · doi:10.5665/sleep.2376 · Cited by 44 · see citing works
Woo, J., Lehrer, H. M., Tabibi, D., Cebulske, L., Tanaka, H., & Steinhardt, M. A. (2024) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001298 · Cited by 5 · see citing works
Sinha, N., Fausto, B. A., Mander, B. A., & Gluck, M. A. (2023) · Journal of Alzheimer s Disease · doi:10.3233/jad-230043 · Cited by 5 · see citing works
Fidler, A. L., Chaudhari, P., Sims, V., Payne-Murphy, J. C., Fischer, J., & Cottler, L. B. (2023) · Journal of Clinical and Translational Science · doi:10.1017/cts.2023.536 · Cited by 5 · see citing works
“It is well established that Black individuals tend to have significantly shorter sleep durations than non-Hispanic White individuals [10,16,17].”
BackgroundResultFonseca, L. M., Finlay, M., Chaytor, N. S., Morimoto, N. G., Buchwald, D., Dongen, H. P. A. V., Quan, S. F., & Suchy‐Dicey, A. M. (2024) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2024.1346807 · Cited by 5 · see citing works
“Also, there is evidence that both sleep disorders (Ruiter et al., 2010; Chen et al., 2015) and cardiovascular diseases (Egan et al., 2017; Zuma et al., 2021) are influenced by race/ethnicity.”
Background
- Authors
- Ruiter, M. E., DeCoster, J., Jacobs, L., & Lichstein, K. L.
- Affiliations
- University of Alabama (US)
- ORCID
- DeCoster, Jamie
- Venue
- Behavioral Sleep Medicine
- Publisher
- Informa UK Limited
- Published
- 2010-09-23
- Volume
- 8
- Issue
- 4
- Pages
- 246-259
- ISSN
- 1540-2002 (ISSN-L)
- 1540-2010
- OpenAlex
- W2023920590
- Semantic Scholar
- dc94d393d30af63cfbc65de9320a9f0738cc95b5
- Cited by
- 152
- References
- 44
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 16 · 2023: 10 · 2022: 12 · 2021: 10 · 2020: 7 · 2019: 14 · 2018: 9 · 2017: 13 · 2016: 10 · 2015: 15 · 2014: 7 · 2013: 11 · 2012: 4
- FWCI
- 0.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavioral Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- sleep disorders, ethnic differences, African Americans, White Americans, insomnia symptoms, sleep-disordered breathing, prevalence, symptom severity, racial disparities
- MeSH terms
- Adult, Aged, Black or African American, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Severity of Illness Index, Sleep Apnea Syndromes, Sleep Wake Disorders, United States, Prevalence, White People
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