Are there racial and ethnic disparities in sleep problems among people with chronic pain? Systematic review and meta-analysis

Abstract

OBJECTIVE: Sleep problems and chronic pain frequently co-occur, but racial and ethnic disparities in sleep problems among individuals with chronic pain are not well understood. This systematic review and meta-analysis synthesized current evidence and identified research gaps. METHODS: We systematically searched PUBMED, MEDLINE, EMBASE, CINAHL, and COCHRANE for English-language studies published by February 28, 2025, reporting the prevalence of sleep problems across racial and ethnic groups with chronic pain. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess methodological quality, and a random-effects model was employed for meta-analysis. RESULTS: Of 3,439 identified citations, eleven studies were included. Of those, nine studies investigated insomnia symptoms, one examined obstructive sleep apnea, and one addressed restless legs syndrome. Regarding conditions, three studies examined chronic nonspecific pain, two focused on fibromyalgia, five on arthritis-related conditions, and one on spinal pain. The pooled prevalence of sleep problems was 60.3% in Asians (95% CI: 35.8-84.9), 50.5% in Black individuals (95% CI: 24.5-75.6%), and 48.2% in White individuals (95% CI: 21.4-75.0%). One study reported 23.7% (95% CI: 10.2-37.2%) from a mixed Hispanic and Asian sample. CONCLUSION: We found that the prevalence of sleep problems does not differ substantially by race as a comorbidity of chronic pain. However, certain groups, such as Hispanics, remain understudied. Most studies focused on insomnia symptoms and a limited range of chronic pain conditions. These findings underscore the need for broader research on diverse sleep problems across various chronic pain conditions and underrepresented racial and ethnic groups.