Mind the Gap: Addressing Pediatric Sleep Disparities and the Role of Sleep Variability

Sleep equity among children belonging to minoritized groups deserves more clinical attention, according to a new report published today in JAMA Network Open. This cross-sectional study found that racially and ethnically diverse pediatric populations continue exhibiting worse sleep outcomes compared with White children. Considering this evidence, the authors advocate for policy reform and enhanced practices to adequately address disparities in sleep health throughout younger populations.1

“Theoretical and empirical work attribute these disparities to structural and interpersonal challenges associated with children’s racially and ethnically minoritized identities, as well as cultural differences in the beliefs and practices related to sleep,” the authors write, pointing to a body of literature that demonstrates how, for example, Black families tend to endure reduced sleep duration and quality compared with non-Hispanic White families.

Insufficient research considers sleep variability throughout Latinx, Asian, and multiracial pediatric populations | image credit: Michael - stock.adobe.com

A primary measure gaining more attention in sleep research is the concept of sleep variability/regularity, which may carry important implications for one’s health equal to that of sleep timing or duration. Emerging research over the years has suggested that sleep regularity or irregularity can contribute to—and be predictive of—numerous health outcomes. Variability may influence people’s cardiac health, metabolic functioning, mental health, cognitive performance and functioning, and more.2

The current authors emphasize the lacking attention that has been paid to racial and ethnic groups outside of Black populations and, in an effort to expand knowledge in this regard, their study leverages actigraphy sleep data from the national Adolescent Brain Cognitive Development (ABCD) study to explore a plethora of pediatric sleep dimensions across White, Black, Asian, Latinx, and multiracial children.1

In total, there were 3868 children included in the analysis aged between 11 and 12 years on average. Nearly half of this group was female (n =1913). Overall, 58.4% (n = 2260) were White, 20.7% (n = 801) were Latinx, 9.2% (n = 356) were multiracial, 9% (n = 347) were Black, and 2.7% (n = 104) were Asian.

Compared with White children, Latinx children exhibited significantly reduced duration of sleep (β = −0.06; 95% CI, −0.10 to −0.03; P = .002), as did multiracial children (β = −0.06; 95% CI, −0.09 to −0.03; P < .001), Black children (β = −0.18; 95% CI, −0.22 to −0.14; P < .001), and Asian children (β = −0.08; 95% CI, −0.11 to −0.04; P < .001). Bed times, compared with White children, were also reportedly later for Latinx children (β = 0.10; 95%CI, 0.06-0.13; P < .001), multiracial children (β = 0.05; 95% CI, 0.02-0.09; P = .003), Black children (β = 0.13; 95%CI, 0.09-0.17; P < .001), and Asian children (β = 0.06; 95% CI, 0.03-0.09; P < .001).

Sleep efficiency was significantly higher in Latinx children vs White children (β = 0.07; 95% CI, 0.03-0.11; P = .01).

The analysis further revealed that Asian children experienced greater degrees of bedtime variability compared with White children (β = 0.04; 95% CI, 0.01-0.07; P = .02). Similarly, Latinx children (β = 0.08; 95% CI, 0.05-0.12; P < .001), multiracial children (β = 0.08; 95% CI, 0.05-0.11; P < .001), and Black children (β = 0.11; 95% CI, 0.08-0.15; P < .001) also had more bedtime variability compared with White children.

Researchers additionally note that multiracial and Black children demonstrated more variability as pertains to sleep duration (multiracial: β = 0.04; 95% CI, 0.01-0.07; P = .04; Black: β = 0.09; 95% CI, 0.05-0.12; P < .001;), as well as sleep efficiency (multiracial: β = 0.04; 95%CI,0.01-0.08; P = .03; Black: β = 0.11; 95% CI, 0.07-0.16; P < .001) when compared with White children.

The researchers conducted additional analyses rotating Black, Latinx, multiracial, and Asian children as the reference group and concluded by stressing that “observed differences can stem from multiple factors, none of which are attributed to the children themselves. Structural racism can expose racially and ethnically minoritized children to unfavorable environments (eg, neighborhoods) characterized by limited access to health care and high levels of crime, noise, and pollution,” pointing to a number of cultural factors that may also influence children’s sleeping habits. Considering their findings, the authors highlight the need to further understand and address pediatric sleep disparities, with added attention to sleep variability and multifaceted sleep dimensions to best promote pediatric sleep health.

References

1. Wang Y, Zhao Z, Zhang Y, et al. Race, ethnicity, and sleep in US children. JAMA Netw Open. 2024;7(12):e2449861. doi:10.1001/jamanetworkopen.2024.49861

2. Fischer D, Klerman EB, Phillips AJK. Measuring sleep regularity: theoretical properties and practical usage of existing metrics. Sleep. 2021;44(10):zsab103. doi:10.1093/sleep/zsab103