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      Insomnia, Short Sleep, And Snoring In Mid-To-Late Pregnancy: Disparities Related To Poverty, Race, And Obesity

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          To characterize sleep habits and parameters among women in mid-to-late pregnancy and to identify disparities associated with poverty, race, and obesity.




          Large multi-site health system in Metro Detroit.


          A total of 267 pregnant women (27.3% non-Hispanic black; gestational age: 27.99±1.20 weeks) completed online surveys on sleep quality, insomnia symptoms, sleep aid use, signs/symptoms of sleep-disordered breathing, and sociodemographics. Body mass index (BMI) and patient insurance were derived from medical records.


          As high as 76.2% of the women reported global sleep disturbance, 30.6% endorsed snoring, 24.3% sleep <6 hrs/night, and over half screened positive for clinical insomnia. Yet, only 3.4% of the women reported an insomnia diagnosis and 3.0% reported a sleep apnea diagnosis. In unadjusted models, poverty, Medicaid coverage, self-identifying as black, and obesity before and during pregnancy (BMI ≥ 35) were associated with a wide range of sleep problems. However, adjusted models revealed specificity. Poverty was uniquely related to increased insomnia symptoms and trouble sleeping due to bad dreams. Obesity before pregnancy was related to poor sleep quality, snoring, sleep aids, and short sleep. Black women reported shorter sleep duration than white women but differed on no other sleep parameters.


          Clinical signs of insomnia and sleep-disordered breathing are common in mid-to-late pregnancy, but most cases go undetected. Problematic sleep disproportionately affects women in poverty, who self-identify as black, and who are obese before pregnancy. Poverty-related sleep issues are linked to insomnia, obesity-related disparities center on sleep-related breathing and medication use, and racial disparities relate to short sleep.

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          Most cited references 45

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          Racial residential segregation: A fundamental cause of racial disparities in health

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            Who gets the best sleep? Ethnic and socioeconomic factors related to sleep complaints.

            Lower socioeconomic status is associated with short or long sleep duration and sleep disturbance (e.g., sleep apnea), which are all related to increased mortality risk. General sleep complaints, however, which may better approximate symptoms as they are experienced, have not been examined in a large population sample. Sample consisted of n=159,856 participants from the Behavioral Risk Factor Surveillance System, representing 36 states/regions across the US. Sleep complaints were measured with a telephone survey item that assessed "trouble falling asleep," "staying asleep" or "sleeping too much." Data analysis utilized hierarchical logistic regression and Rao-Schott chi(2). Asian respondents reported the least complaints, and Hispanic/Latino and Black/African-American individuals reported fewer complaints than Whites. Lower income and educational attainment was associated with more sleep complaints. Employment was associated with less sleep complaints and unemployment with more. Married individuals reported the least sleep complaints. Significant interactions with race/ethnicity indicate that the relationship between sleep complaints and marital status, income and employment differs among groups for men, and the relationship with education differs among groups for women. Rates of sleep complaints in African-American, Hispanic/Latino and Asian/Other groups were similar to Whites. Lower socioeconomic status was associated with higher rates of sleep complaint. Copyright 2010 Elsevier B.V. All rights reserved.
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              Racial differences in self-reports of sleep duration in a population-based study.

              Racial and ethnic differences in sleep duration are not well understood. Research shows that short ( or =9 hours) sleepers have higher mortality risks than mid-range sleepers. We investigated whether sleep duration varies by racial and ethnic characteristics and if some of these associations may be explained by residential context. Cross-sectional National Health Interview Survey. Non-institutionalized adults living in the United States in 1990. 32,749 people aged 18 years or older. We estimate a multinomial logistic regression that predicts short, mid-range, and long sleep duration; including covariates for race/ethnicity, among other demographic, health, and neighborhood characteristics. Black respondents had an increased risk of being short and long sleepers (OR=1.41, 95% CI=1.27-1.57 and OR=1.62, 95% CI=1.40-1.88, respectively) relative to white respondents. Hispanics (excluding Mexican Americans) and non-Hispanic "Others" were also associated with increased risk of short sleeping (OR=1.26, 95% CI= 1.07-1.49 and OR=1.35, 95% CI= 1.11-1.64, respectively). Living in an inner city was associated with increased risk of short sleeping and reduced risk of long sleeping, compared to non-urban areas. Some of the higher risk of short sleeping among blacks can be explained by higher prevalence of blacks living in the inner city. Blacks and other racial minorities are more likely to have sleep durations that are associated with increased mortality. The results are consistent with the hypothesis that unhealthy sleep patterns among minorities may contribute to health differentials.

                Author and article information

                Nat Sci Sleep
                Nat Sci Sleep
                Nature and Science of Sleep
                04 November 2019
                : 11
                : 301-315
                [1 ]Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System , Novi, MI, USA
                [2 ]Department of Obstetrics and Gynecology, Henry Ford Health System , Detroit, MI, USA
                [3 ]Departments of Obstetrics &Gynecology and Neurology, University of Michigan , Ann Arbor, MI, USA
                [4 ]Department of Psychiatry, University of Michigan Medical School , Ann Arbor, MI, USA
                [5 ]Departments of Neuroscience and Psychiatry, University of Pisa , Pisa, Italy
                [6 ]Division of Sleep Medicine, Henry Ford Health System , Detroit, MI, USA
                Author notes
                Correspondence: David A Kalmbach Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System , Novi, MI, USATel +1248 325 3938 Email dkalmba1@hfhs.org
                © 2019 Kalmbach et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Tables: 5, References: 56, Pages: 15
                Original Research

                sleep aids, sleep apnea, medicaid, perinatal, prenatal


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