Differences in Sleep Patterns and Problems by Race in a Clinical Sample of Black and White Preschoolers

Abstract

Study Objectives: Community-based research indicates that Black preschoolers tend to have more bedtime difficulties and are at higher risk for obstructive sleep apnea (OSA) compared to White preschoolers. This study examined differences in sleep patterns and problems by race among a clinical sample of Black and White preschoolers at an outpatient sleep clinic. Methods: Data were collected from electronic medical records for 125 children ages 2-5 years (mean = 3.37 years, 64.0% White, 36.0% Black; 59.2% male) presenting at a pediatric sleep clinic in an academic medical center. Neighborhood income data were based on ZIP codes entered into the United States Census Bureau's American Fact Finder. Results: Black patients (51.1%) were significantly more likely than White patients (20.0%) to bed-share with a caregiver (χ 2 = 12.99, P ≤ .001). There were no other significant differences in presenting sleep patterns (bed/wake times, sleep onset latency, naps, night awakenings, or sleep opportunity). Logistic regressions showed that White patients were more likely to present with difficulty falling/staying asleep and receive an insomnia diagnosis, and Black patients were more likely to present with OSA-related concerns and receive a diagnosis of suspected OSA, even when controlling for relevant sociodemographic covariates. Conclusions: In contrast to community-based research, Black and White children showed similar sleep patterns. However, there were differences by race in referral questions and diagnoses. Findings suggest the need to consider caregiver perceptions and other sociocultural factors that may contribute to differential rates of presentation for sleep services, as well as potential health disparities in this regard. I NTRO DUCTI O NAlthough sleep problems affect 20% to 30% of infants, preschoolers, and kindergarteners, 1,2 recent research indicates that young children from non-White racial/ethnic backgrounds are at increased risk of experiencing sleep difficulties compared to non-Hispanic/Latino White youth (hereafter the term "White" will be used to reference non-Hispanic/Latino White racial/ ethnic background). Specifically, studies comparing Black and White children have found that racial/ethnic background is a significant predictor of variation in preschoolers' sleep regularity, duration, and quality.3-5 Community-based studies have shown that Black preschoolers are more likely than their White peers to exhibit symptoms of behavioral sleep disturbances, such as increased bedtime resistance, longer sleep onset latency, and shorter total sleep duration.5-8 Aspects of sleep routines and the sleep environment also differ by race, with Black children showing later bedtimes and decreased likelihood of following a regular bedtime routine, 5,6,8,9 as well as higher rates of parent-child bed-sharing. 10,11 Later bedtimes and less regular bedtime routines have been associated with increased child sleep disturbances, 2,12,13 and research on the effect of bed-sharing on child sleep is mixed.11 Some families may choos...

Disparities in Sleep Health and Potential Intervention Models

“…Exacerbating sleep health disparities, nonwhite children and those of lower SES may lack consistent access to health-care services. 73 Although more research is needed, some studies have found differences by race in practice patterns related to both general pediatric sleep services 74 and OSA diagnosis and treatment. 75 Innovative methods to promote sleep health and increase sleep problem identification and treatment are necessary to help reduce these disparities.…”