Is Sleep Apnea Risk Higher for Asians?

As obesity rates climb to epidemic levels in nearly every U.S. state, one population may need to be especially weary of a serious sleep disorder linked to weight gain. People of Asian descent tend to have more severe obstructive sleep apnea than Caucasians of similar age and BMI.

The findings are especially alarming because the Caucasians in the sample tended to be much more overweight than their Asian counterparts. Differences in facial bone structure appear to be the reason why Asians have a higher risk for OSA.

The findings were the result of a joint study between University researchers in Australia and China published in the August issue of the journal SLEEP. A sample of 74 Caucasian patients from an Australian clinic and 76 Chinese patients from a clinic in Hong Kong underwent a sleep study and a series of physical and x-ray measures.

OSA prevalence was similar for both populations, but Caucasians with OSA tended to be more overweight with a larger neck circumference. Chinese patients had smaller, more restrictive facial structures. When BMI measurements were similar the Chinese participants suffered from more frequent and severe breathing pauses during sleep.

The study may have some limitations due to the nature of the sample. The patients came from two very different environments and socioeconomic and culture backgrounds. Researchers caution that those factors influence the health and lifestyle habits that lead to OSA.

OSA isn’t the only sleep disorder influenced by race. An abstract presented at SLEEP 2010 showed black, white and Hispanic people all responded differently to sleep deprivation and insomnia.

Study: sleep disturbance symptoms differ by race

New research shows the exact effects of sleep disturbances differ by race.

A study published this month in the Journal of Clinical Sleep Medicine compared symptoms for white, black and Hispanic people.

Each participant filled out a survey about their symptoms, after scientists monitored their sleep.

Black participants who had insomnia symptoms, excessive daytime sleepiness or frequently snored reported poorer physical health compared to their white counterparts. Black people with insomnia also had more physical limitations than Hispanics, and worse mental health than whites.

Hispanics with those same sleep issues had more mental distress than white people.

Researchers found sleep disturbances were common for the overall population; 46 percent had at least mild sleep apnea, 34 percent reported frequent snoring, 30 percent had insomnia and 25 percent reported excessive daytime sleepiness.

Excessive snoring was most common among Hispanics, affecting 41 percent studied. Nearly a third of black people struggled with daytime sleepiness, the most in the study.

Due to limitations of the studies design, researchers could not examine what causes those differences. They speculate lifestyle, diet, sleep architecture and access to health care could be factors.

The 2010 Sleep in America Poll highlights sleep differences for each race. Blacks were most likely to be “short sleepers,” those surveyed averaged 6.2 hours of sleep on weekdays. Whites had the highest average of 6.9 hours.

According to CDC data, unemployed and low-income Americans have more trouble sleeping. High school dropouts are about twice more likely to have sleep disturbances than people with college degrees.

Learn more about sleep and race.

Image Courtesy John Steven Fernandez

Sleep & Race in America

Author Studs Terkel called race “the American obsession.” In the U.S. race colors almost everything we do – even sleep.

Today the National Sleep Foundation released the results of the 2010 Sleep in America Poll. It focused on the relationship between sleep and race.

Telephone interviews were conducted with 1,007 adults between the ages of 25 and 60. The sample was equally divided among four groups: Asians, blacks, Hispanics and whites.

Results show that the average reported nightly sleep time on workdays or weekdays was less than seven hours in each group. Blacks had the lowest average of 6.2 hours, and whites had the highest average of 6.9 hours.

About 60 percent of blacks were “short sleepers” who reported sleeping less than seven hours per night during the week. Fifty percent of Hispanics, 41 percent of Asians and 34 percent of whites also were short sleepers.

The AASM reports that individual sleep needs vary from one person to another. But most adults need about seven to eight hours of nightly sleep.

Other surveys also have found that self-reported sleep durations differ by race. A recent analysis of time-use surveys found that African-Americans had higher odds of short sleep. Asians and Hispanics were less likely to be short sleepers. Survey data released by the CDC last year suggested that Hispanics were more likely to be sound sleepers.

Research also has been linking short sleep with health problems such as obesity and type 2 diabetes. Habitual sleep duration may help explain why the rates of these problems can vary widely by race.

The CDC reports that blacks are 51 percent more likely to be obese than whites. Hispanics are 21 percent more likely to be obese than whites.

And last year a study found that blacks had a 78 percent increased risk of obesity related to short sleep. The risk of obesity related to short sleep in whites was increased by 43 percent.

So where do you fit in these statistics? Regardless of your race, are you getting enough sleep?

Maybe you need to make it a priority to get more sleep. Perhaps you can turn off the TV or the computer 30 minutes earlier at night.

Or maybe you have a problem that prevents you from sleeping well. Insomnia. Sleep apnea. Restless legs. Or one of the many other sleep disorders. In this case it may be time for you to contact an AASM-accredited sleep center for help.

Getting enough sleep – and sleeping well – will help you feel, think and perform your best. Maybe sleep should become the new American obsession.

Read about other recent sleep surveys and learn more about sleep and race.

Sleep, Weight & Abdominal Fat

A new study examined the relationship between sleep duration and abdominal fat in a group of Hispanic and African-American young adults. The results were published today in the journal Sleep.

The study involved 1,107 adults between 18 and 81 years of age. Data were collected from 332 African-Americans and 775 Hispanics. Sixty-two percent of participants were female.

Body mass index (BMI) and abdominal fat were measured at a five-year interval. Belly fat was measured using abdominal computed tomography (CT) scans.

Results show that the mean self-reported nightly sleep duration was 6.7 hours at baseline. Seventeen percent of the sample reported sleeping five hours or less per night.

There was no link between sleep duration and abdominal fat change in people older than 40 years of age. But short and long sleep durations were associated with increases in BMI and belly fat in people younger than 40 years of age. The association was strongest in people who reported sleeping five hours or less per night.

They had an average BMI increase over five years that was 1.8 kg/m2 higher than people who slept six to seven hours each night. They also gained more abdominal fat.

“Appropriate amounts of sleep are important for maintenance of healthy weight,” lead author Dr. Kristen Hairston told the AASM. “In a group of African-American and Hispanic participants, those who slept less than this had greater increases in belly fat over a five-year period.”

The CDC reports that blacks are 51 percent more likely to be obese than whites. Hispanics are 21 percent more likely to be obese than whites.

The authors proposed that short sleep may promote abdominal fat gain by increasing hunger and caloric intake. It also may increase fatigue and reduce energy expenditure. Both increased caloric intake and decreased vigorous activity were observed in the short sleep group.

The authors also suggested that doctors should educate young adults about the important role of sleep in a healthy lifestyle. This is most important when young adults transition to life stages that often involve sleep deprivation. These include entering college, getting married and having children.

Last year a study found that blacks had a 78 percent increased risk of obesity related to short sleep. The risk of obesity related to short sleep in whites was increased by 43 percent.

Read more about sleep and weight gain and sleep and race.

Image by Jen R

Race & Daytime Sleepiness

Are African-Americans sleepier than whites?

Both a 2003 study and a 2006 study reported that African-Americans have higher scores than whites on the Epworth Sleepiness Scale. The ESS measures how likely you are to fall asleep in eight common situations.

Why might African-Americans score higher on the ESS? It could be that they are more sleep deprived than whites; or perhaps they are more likely to suffer from sleep-disrupting disorders such as obstructive sleep apnea.

Or maybe there is another explanation. A study in the Aug. 15 issue of the Journal of Clinical Sleep Medicine investigated.

The study analyzed the ESS scores of 687 patients who were referred to a hospital-based sleep clinic; 52 percent were African-American. The results were validated in a second group of 712 adults; 57 percent of these people were African-American.

Results show that in both groups, African-Americans had higher average ESS scores than whites. Statistical adjustments were made for factors such as sleep duration, body mass index and sleep apnea severity; they had little effect on the difference.

Further analysis showed that the difference in scores may be explained by two of the ESS questions: African-Americans in both groups were more likely than whites to report excessive sleepiness on questions six and seven.

Question six of the ESS asks how likely you are to fall asleep while “sitting and talking to someone.” Question seven measures sleepiness while “sitting quietly after lunch without alcohol.”

The authors suggest that the ESS is not measuring sleepiness consistently between African-Americans and whites. If one group really were sleepier than another, then their scores should be higher on all eight questions.

So what is it that causes the difference in scores for these two questions? The authors are unsure.

They speculate that there may be cultural differences in how the wording is interpreted. Or different life experiences may cause responses to differ. They cite a 2002 study, which found that culture can affect response patterns.

The ESS was developed in Australia and published in the journal Sleep in 1991. Since then it has been translated into other languages such as Spanish, Chinese, Greek and Turkish. But the authors report that it has never been validated in an African-American population.

So does an ethnic difference in daytime sleepiness really exist? It remains unclear. But the authors conclude that studies using an objective measure such as the multiple sleep latency test could shed light on the answer.

Race, Sleep & Obesity

A study that was presented this week at SLEEP 2009 in Seattle, Wash., examined the link between race, sleep and obesity.

The study involved 29,818 U.S. adults. The data came from the 2005 National Health Interview Survey. Information was collected during face-to-face interviews.

Results show that 52 percent of blacks and 38 percent of whites were obese. Only 23 percent of blacks and 30 percent of whites reported sleeping seven hours per night. Blacks also were more likely than whites to have a “short sleep” duration of five hours or less per night.

So was there a connection between race, sleep and obesity?

Statistical analysis showed that blacks had a 78 percent increased risk of obesity related to short sleep; the risk of obesity related to short sleep in whites was increased by 43 percent.

“Both black and white Americans who were obese tended to have short sleep duration,” study author Girardin Jean-Louis, PhD, told the AASM.

Learn more about sleep and weight on SleepEducation.com.

Who Sleeps Better?

A study being presented today at SLEEP 2009 in Seattle, Wash., examined sleep complaints in the U.S. Results show major differences based on marital status, income, employment and education.

The study examined CDC data involving 159,856 people. They were asked how often they had trouble falling asleep, staying asleep or sleeping too much. “Sleep disturbance” was defined as seven or more days of sleep problems over the last two weeks.

Results indicate that about 19 percent of Americans had disturbed sleep. What were the most important factors?

One was marital status. Almost 31 percent of people who were “separated” and 21 percent of people who had never been married had disturbed sleep; only about 16 percent of married people had trouble sleeping.

Another factor was income. About 26 percent of people who made less than $10,000 per year had disturbed sleep. This rate dropped as income increased; only about 8 percent of people making $75,000 or more had trouble sleeping.

There also were dramatic differences based on employment status. Almost 52 percent of people who were unable to work had disturbed sleep; nearly 32 percent of people who had been unemployed less than a year had trouble sleeping. Only about 16 percent of workers and 17 percent of retired people were sleep disturbed.

Trouble sleeping also decreased with education level. More than 27 percent of people who didn’t finish high school had disturbed sleep; this figure dropped to less than 14 percent for people with a college degree.

Race had less of an effect on sleep. Sleep disturbance occurred in about 19 percent of whites, blacks, Hispanics and Asians. But almost 27 percent of people who are multiracial reported having disturbed sleep.

Happier Marriage, Better Sleep

A new study shows that marriage can affect your sleep – for better or worse. Results show that happily married women sleep better than women who are less satisfied with their marriage.

Women rated their “degree of happiness” with their marriage. They also provided information about any struggles they have with insomnia.

“We found that happily married women report fewer sleep disturbances,” lead author Wendy Troxel, PhD, told Reuters. This included difficulty falling asleep, nighttime awakenings, early morning awakenings and restless sleep.

The study involved a racially diverse sample of women. A Pitt news release reports that there were differences in sleep quality based on race.

Caucasian and African-American women had more sleep complaints. Japanese, Hispanic and Chinese women had fewer sleep complaints. Caucasian and Japanese women reported the highest marital happiness.

The study had controls for other factors that may affect sleep. These included depression, finances and employment. Marital happiness still emerged as an independent risk factor for sleep problems.

An earlier study of older couples also linked sleep problems and marital happiness. It found that having a spouse with sleep problems was related to having an “unhappy marriage.”

A Japanese study also linked being unmarried with poorer sleep quality.

Click here for more about women and sleep.