0332 Objective and subjective sleep quality in Mexican Americans and non-Hispanic Whites: the HABLE-Dormir Study

Abstract

Introduction: Structural inequalities perpetuate poor health outcomes. Sleep inequality, which is the disproportionate burden of sleep problems among marginalized groups compared to historically advantaged groups, is poorly understood. While racial discrimination is associated with chronic health outcomes, few studies have examined the health impact of discrimination stemming from multiple social vulnerabilities. The current study assessed women veterans' experiences of intersectional discrimination, specifically the combined impact of gender and racial/ethnic discrimination on sleep health. Methods: Data were from the WISE (Women Improving Sleep through Education) study. Participants were women veterans with a previous diagnosis of sleep apnea or 1 or more risk factors for sleep disordered breathing (n=39). Data collection was from 3/2021-11/2021. The 9-item Major Discrimination Scale (MDS) and 10-item Everyday Discrimination Scale (EDS) were employed. The MDS included items such as "have you ever been unfairly stopped, searched, questioned, physically threatened or abused by police?" and the EDS, "how often on a day-today basis are you treated with less courtesy than other people?". Items were adapted to assess discrimination related to respondents' gender and race/ethnicity separately. Major intersectional discrimination (MDS-gender + MDS-race/ethnicity) and everyday intersectional discrimination (EDS-gender + EDS-race/eth-nicity) were computed. Sleep health was assessed by the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Descriptive statistics and correlational analyses were performed. Results: Racial/ethnic minority women veterans comprised 54% of the study sample. Prevalence of major intersectional discrimination was 67% and everyday intersectional discrimination, 92%. Compared to other racial/ethnic groups, the proportion of Black women veterans reporting major intersectional discrimination was highest (78%). Major intersectional discrimination was positively correlated with ISI (p=0.04) and PSQI (p=0.01). Everyday intersectional discrimination was not correlated with sleep health (p>0.05). Conclusion: Pilot study findings highlight the potential role of discrimination on sleep health, particularly multiple forms of discrimination. High prevelence of intersectional discrimination related to women veterans' gender and racial/ethnic identities was observed. Major intersectional discrimination, not everyday intersectional discrimination, was associated with higher insomnia severity and poorer sleep quality. Introduction: The ongoing prospective Health & Aging Brain among Latino Elders (HABLE)-Dormir Study is designed to investigate the association between objective and subjective sleep quality and cognitive impairment among Mexican Americans and non-Hispanic Whites (NHWs). Methods: We plan to recruit 1000 community-dwelling Mexican Americans and NHWs and elders (age 50 and above). Objective sleep duration and fragmentation were assessed by 7-day wrist actigraphy; presence of sleep disordered breathing (SDB) was determined using WatchPAT; and subjective sleep quality and excessive daytime sleepiness (EDS) were examined by Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), respectively. Results: To date, 367 participants have been enrolled (62% women, 45% Mexican Americans, mean age 67.3±8.4 years); 296 (81%) of the participants had normal cognition, 56 (15%) had mild cognitive impairment (MCI), and 15 (4%) had dementia. On average, participants had a mean sleep duration of 7.3±1.1 hours, sleep efficiency of 88.3±5.3%, and wake after sleep onset (WASO) of 55.2±29.3 minutes. Almost half (51%) of the participants had moderate to severe SDB defined by WatchPAT-derived respiratory event index (REI) >=15, 54% had self-reported poor sleep quality (PSQI>5), and 10% reported EDS (ESS>=11). After adjustment for age, Mexican Americans had lower sleep efficiency (86.5% vs. 89.5%, p<0.001) and greater WASO (63.6 vs. 48.9 minutes, p<0.001), compared to NHWs. Sleep duration did not differ significantly among NHWs (7.2 hours) and Mexican Americans (7.4 hours); p=0.20. The prevalence of moderate to severe SDB was similar in NHWs (51.2%) and Mexican Americans (50.0%); p=0.84. Besides, NHWs and Mexican Americans had similar PSQI and prevalence of EDS. Conclusion: In this initial analysis, Mexican Americans have worse objective sleep quality, but similar sleep duration, prevalence of SDB and subjective sleep quality as compared to NHWs. Continued investigations are needed to explore potential racial/ ethnic disparities in sleep health and how differences in objective and subjective measurements vary by race and ethnicity. Support (If Any):