Racial and Ethnic Disparities of Sleep Identified for Pregnant Women

Maristella Lucchini, PhD

As previous data have linked poor sleep to adverse maternal outcomes, new findings from the Child Health Outcomes (ECHO) program identified stark racial differences among pregnant women in terms of sleep health, and more specifically, sleep duration and sleep disturbances.¹

The complete dataset, published in SLEEP, came less than a month after the first results were presented at the 2022 SLEEP Annual Meeting, June 4-8, in Charlotte, North Carolina. Among the key findings, non-Hispanic Black/African American (nHB/AA) participants reported shorter sleep duration (second trimester [T2]: ß = –0.55 [95% CI, 0.80 to –0.31]; T3: ß = –0.65 [95% CI, –0.99 to –0.31) and more disturbances (T2: ß = 1.92 [95% CI, 1.09-2.75]; T3: ß = 1.41 [95% CI, 0.09-2.74]), but not worse subjective sleep quality compared with non-Hispanic White (nHW) participants. Between non-Hispanic Asian (nHA) and nHW participants, there were no significant differences in any sleep domain across trimesters.

Lead investigator Maristella Lucchini, PhD, research assistant, Columbia University Irving Medical Center, and colleagues concluded that "results from this study could inform the identification of modifiable factors and targeted interventions to improve barriers to sleep health with potential positive effects for downstream health outcomes among pregnant people and their children." They also noted that that further research is warranted to investigate the determinants of sleep disparities.

Another major take-home point from the study was that Hispanic participants reported longer sleep duration (T1: ß = 0.22 [95% CI, 0.00004-0.44]; T2: ß = 0.61 [95% CI, 0.47-0.76]; T3: ß = 0.46 [95% CI, 0.22-0.70]), better sleep quality (very good;. Fairly good T1: odds ratio [OR], 0.48 [95% CI, 0.32-0.73]; T2: OR, 0.36 [95% CI, 0.26-0.48]; T3: OR, 0.31 [95% CI, 0.18-0.52]. Fairly bad T1: OR, 0.27 [95% CI, 0.16-0.44]; T2: OR, 0.46 [95% CI, 0.31-0.67]; T3: OR, 0.31 [95% CI, 0.17-0.55]) and fewer sleep disturbances (T2: ß = –0.5 [95% CI, –1.0 to –0.12]; T3: ß = –1.21 [95% CI, –2.07 to –0.35]) than nHW participants.

Launched by the National Institutes of Health in 2016, the ECHO research program is designed to understand the effects of a broad range of early environmental factors on child health and development. Composed of 69 existing longitudinal cohorts, the analysis collapsed race and ethnicity information into 4 categories to maximize the number of meaningful categories given the available sample size: nHW, nHB/AA, Hispanic, and nHA.

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Across all races, mean nighttime sleep duration was the highest in the first trimester (8.5 [±1.5] hours) and decline in the second (8.0 hours [±1.5]) and third (7.3 hours [±1.6]) trimesters. Hispanic participants reported the longest nighttime sleep duration in the first two trimesters (8.75 hours [±1.70]; 8.51 hours [±1.47]), while nHA participants reported the longest in the third (7.96 hours; ±1.14). Even in a stratified analysis of Hispanics who obtained high school education, the differences for nHW participants between the second and third trimesters remained.

Subjective sleep quality was rated as fairly good for most participants in all 3 trimesters, but consistently better sleep quality was observed in Hispanic participants than other racial/ethnic groups. By each trimester, nHA participants reported their highest sleep quality in the third trimester (20.6%), while all other groups reported their highest sleep quality in the second trimester. Across all trimesters, investigators found significantly lower odds to report fairly good and fairly bad subjective sleep quality in Hispanic participants when compared with nHW participants and using very good subjective sleep quality as a reference.

Sleep disturbance score, captured using the fifth question from the Pittsburgh Sleep Quality Index, was most consistently high in the nHB/AA group. Hispanic participants averaged the lowest sleep disturbances score in the first 2 trimesters (7.18 [±4.28]; 7.50 [±4.28]), while nHA participants averaged the lowest in the third (8.59 [±3.45]). In regression analyses, nHB/AA participants reported more sleep disturbances than nHW participants across all trimesters, and results remained significant after adjusting for BMI and age in the second and third trimesters.

REFERENCE
1. Lucchini M, O’Brien LM, Kahn LG, et al. Racial/ethnic disparities in subjective sleep duration, sleep quality, and sleep disturbances during pregnancy: an ECHO study. SLEEP. Published online June 21, 2022. doi:10.1093/sleep/zsac075