Review concludes that polysomnography tests should be used to study socio-economic effects on sleep

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A recent review concluded that polysomnography tests have objective value in assessing the effect of socioeconomic status on sleep quality.

In a review published in Clocks and Sleepone researcher concluded that polysomnography (PSG) testing offered the best opportunity to assess the relationship between socioeconomic status (SES) and sleep quality at an objective level.

The author said other sleep studies have used self-reported instruments, like the Insomnia Severity Index and the Pittsburgh Sleep Quality Index, while very few research studies on sleep and health disparities had used objective measures like PSG in their research.

PSG tests measure the electrical activity of the brain, eye and muscle movements during sleep. They also measure sleep phases and cycles to identify sleep disorders. The aims of the review were to analyze how SES-based sleep health disparities are measured with PSG in the general population and to suggest improvements for clinical practice.

For this review, 7 studies were selected for inclusion, all cross-sectional. The author identified useful studies by searching the PubMed/MEDLINE and Google Scholar databases between January 2000 and April 2021. Key words such as Socioeconomic status, sleep, polysomnographyand sleep quality were used to find relevant studies. Studies were excluded if they were interventional trials; if they were not written in English or French; if they did not present original research, did not have the full text accessible or did not provide statistical significance on the subject; whether their authors recruited participants; or if they used actigraphy instead of PSG.

Of the 7 studies, 3 were from the United States, 2 from Switzerland, 1 from India and 1 from Brazil. All participants in these 7 studies were adults and represented a global population of 7638 people. The participants were between 18 and 81 years old. SES was identified by education in 5 studies, income in 3 studies, occupation and professional position in 2 studies, composite score/perceived SES in 2 studies and employment in 1 study.

Sleep parameters measured in these studies included sleep duration, sleep efficiency, sleep latency, sleep architecture, stage changes, wake-up after sleep onset (WASO), continuity sleep and total sleep time. The duration of the PSG readings varied from 1 to 3 nights.

The results identified lower SES as being associated with longer sleep latency, more WASO, less sleep efficiency, and higher stage changes in PSG. Participants with lower childhood SES spent more time in stage 2 sleep and less time in slow wave sleep than participants with higher childhood SES, regardless of their current SES status. Financial constraints were significantly correlated with lower subjective sleep quality and PSG-assessed sleep continuity.

Men with a low level of education or a professional position were more likely to experience poor sleep quality, short sleep duration or insomnia. Men with a low occupational position were also more likely to have long sleep latency. Women with low education were more likely to have long sleep latency and short sleep duration. They were also more likely to have excessive daytime sleepiness if they were in a low occupational position.

Women from low childhood SES backgrounds had longer sleep latency than women from the high childhood SES group. A study found that SES affects the risk of obstructive sleep apnea (OSA) differently for men and women, with low income acting as a moderator in the relationship between SES and individual sleep. Another study reported that the association between home PSG measures of OSA and SES was mediated by body mass index.

The author said this review provided evidence that PSG can be used to find individual differences in sleep health in people with or without a sleep disorder. PSG studies should always collect data on SES to better identify the relationship between SES and sleep quality, the author noted. It may also be possible to study these SES indicators and sleep quality over time.

The review identified SES as having an impact on the objective measure of sleep. However, the author noted that all of the studies used were conducted in developed countries. Studies in developing countries were needed to draw a meaningful conclusion about the relationship between SES and sleep quality.

The review concluded that PSG provided more useful detail that can objectively indicate sleep health disparities more accurately than subjective ratings. Courses on the use of PSG should be given to researchers and students to increase the use of PSG in sleep studies, the author wrote, and prices for test devices should be maintained. reasonable by manufacturers to ensure accessibility.

Reference

Etindele Sosso FA. Measuring sleep health disparities with polysomnography: a systemic review of preliminary results. Sleep Clocks. 2022;4(1):80-87. doi:10.3390/clockssleep4010009

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