What is healthy sleep? “Healthy sleep requires adequate duration, good quality, appropriate timing and regularity, and the absence of sleep disturbances or disorders. (15)
As a result of socioeconomic status and environmental factors, underserved populations are disproportionally impacted by health disparities. Undiagnosed sleep disorders and insufficient sleep have an influence on those disparities. The result is higher disease burden, earlier mortality, lower quality of life, and contributing to financial medical debt.
Sleep Equity Project seeks to identify and refine issue which can be addressed on a variety of levels (Individual, Family, Community, Societal). Dr. Paula Braveman, et al cited that "effective public policy requires clear and contextually relevant operational definitions to support the development of objectives and specific targets, determine priorities for use of limited resources, and assess progress." (16) This will be a guiding concept of Sleep Equity Project as we go through our process of identifying, refining and prioritizing our core issues.
Access, Affordability, Health Equity, and Patient Safety
Our focus on specific issues all fall under one of these core issues faced by underserved people in the area of sleep.
Our next steps are to:
1. Identify and refine issues which impacts sleep equity
2. Determine if developing programing or an advocacy agenda is appropriate
3. Seek partners to collaborate (patients, organizations, practitioners, caregiver, industry)
4. Explore funding sources to support the development of programing
Patients are less aware of the immediate impact of sleep apnea can have on various physiological states such as nightly blood pressure; pre and post surgical considerations; and variation of pulse oxygen saturation.
The presence of sleep disorders can have a wide ranging impact on blood pressure; amount of anesthesia needed for a surgical procedure as well as safety factors post surgery; and effectiveness of monitoring of arterial oxygen saturation. The awareness of these issues is critical when faced with either an emerging health issue or managing an ongoing chronic health issue which can impact a sleep patient's quality of life and lead to less optimal health outcomes.
Underserved people in the U.S. have barriers to access and affordability of sleep assessments and treatments.
Sleep assessment, diagnosis, and treatment is not attainable for many people in the U.S. because of cost, silos of access, Center for Medicaid and Medicare (CMS) only allowing in lab studies for Medicare patients. These issues contribute to the lack of diagnosis and opportunity to treat a contributing factors (insufficient sleep & sleep disorders) to chronic health problems. Even commercially available sleep trackers are costly and more attainable for those with more financial resources. Sleep is not a luxury and access to healthy sleep should be accessible to all across the lifespan.
Women are less likely to be tested and diagnosed with sleep disorders due to differing signs and symptoms, gender bias and perpetuated societal myths.
Signs, symptoms, and prevalence for some sleep disorders (sleep apnea, insomnia, restless leg syndrome) differ for women and a lack of knowledge and gender bias among medical professionals contributes to less women being assessed and properly treated. Furthermore, societal myths about sleep disorders and gender plays a role in minimizing the prevalence of sleep disorders among women. Sleep disorders are a lifespan issue for all, and in particular for women who experience hormonal shifts during the onset of puberty, menstrual cycles, pregnancy, and menopause which can alter sleep architecture. (17) This bias in medicine and societal myths combine to put women at undue health risk for complications from chronic health conditions and can impact quality of life and mortality.
Sleep disorders and co-occurring major chronic health conditions have a disproportionate impact on underserved populations.
Sleep disorders are under recognized as a co-occurring health condition with many major chronic health issues such as cardiovascular disease, diabetes, liver disease, and eye conditions. The impact this is magnified in underserved populations who suffer disproportionally from major chronic health conditions due to socioeconomic and environmental factors.
ACCESS & AFFORDABILITY
Extending Gains Made Through Sleep Disparity Research Is Essential to Helping More Underserved Communities
Major strides have been made in the last 30 years in the area of sleep disparity research around the impact of the social and environmental determinants of health. Supporting this area of research is important to learn how tailoring culturally appropriate treatment interventions can benefit those who are underserved and underdiagnosed.
Sleep disparity researchers and practitioners have implemented interventions in the community which have made improvements in sleep quality and quantity. The challenge is engaging more underserved communities for participation and learn who is best served by which interventions.
Cultural Stereotypes and medical bias hamper access to assessment and treatment of sleep disorders for underserved communities.
Implicit bias in medical care shows up in the belief that treatments developed in clinical studies involving primarily white subjects is effective for all others. This shows up in a variety of manners-pulse oxygen sensors are not as effective in reading people who have darkened skin (18); Racial and ethnic disparities exist in the utilization of tonsillectomy and adenoid surgery (T&A) for children with Sleep Disordered Breathing enrolled in Medicaid (19).
There exists a racial and gender disparity in sleep disorder related mortality in the U.S.
The impact of sleep disorders and mortality rate for minorities and women in the United States should be treated as a more pressing concern by public health and primary care. Despite the studies which show some correlation, the possible causal factors are complex and multi-factorial.